What's new in... Capnography Monitoring for Dental Conscious Sedation: A Clinical Review.

Capnography monitoring during conscious sedation is not currently required for dentistry in Britain and Ireland. Other countries have introduced guidelines and standards requiring capnography monitoring for procedural sedation. This review highlights the variability of procedural sedation including the setting, the position on the sedation continuum, and the routine use of supplemental oxygen. Specific research is required for conscious sedation in a dental setting to support standards and guidelines with regard to capnography monitoring. The Academy of Medical Royal Colleges and their Faculties emphasise that each specialty must produce its own guidance for the use of sedative techniques.1 Clinical practice guidelines for the monitoring and safe practice of sedation vary by specialty and institution. Standards are generally set from the best available evidence based research. There is a growing body of literature that recognises the potential additional value of capnography (ETCO2) monitoring during procedural sedation in different settings and for different sedation techniques.2-5 In these studies, capnography reduced the incidence of hypoxaemia during procedural sedation. A meta-analysis published by Waugh et al. (2010) concluded that end-tidal carbon dioxide monitoring is an important addition in detecting respiratory depression during procedural sedation.6 A more recent systematic review by Conway et al. (2016) concluded that patients monitored with capnography in addition to standard monitoring had a reduced risk of hypoxaemia compared to those with only standard monitoring.7 However, it has to be noted that both the Waugh and Conway reviews contained substantial statistical heterogenicity which is likely to affect the quality of the evidence. As research evidence for capnography monitoring from the medical settings studied became available, new standards for capnography monitoring were introduced in several countries (Table 1).

Patch testing for food-associated allergies in orofacial granulomatosis.

BACKGROUND: Food-associated allergies, especially to benzoates and cinnamon-related compounds, have been associated with orofacial granulomatosis and both standard and urticarial patch testing have been used to detect such allergies. Elimination diets have also been shown to be effective in some patients. OBJECTIVES: To compare the results of standard and urticarial patch testing in a cohort of patients with orofacial granulomatosis. MATERIALS AND METHODS: Records of 120 cases seen in two hospitals were retrieved and examined for patch test details. RESULTS: Standard patch testing was much less likely to detect allergy to benzoates and cinnamon compounds (7%) than urticarial tests (55%). All urticarial tests that were positive had shown a reaction by 60 min. CONCLUSIONS: Both standard and urticarial patch tests are required to detect food allergies in orofacial granulomatosis. The difficulties of patient self-recording of urticarial tests can be eliminated by retaining patients in the testing unit for professional reading of patches at 60 min.

Genetic characterization of a phospholipase C gene from Candida albicans: presence of homologous sequences in Candida species other than Candida albicans.

Phospholipase C (PLC) enzymes are essential in regulating several important cellular functions in eukaryotes, including yeasts. In this study, PCR was used to identify a gene encoding PLC activity in Candida albicans, using oligonucleotide primers complementary to sequences encoding highly conserved amino acid regions within the X domains of previously characterized eukaryotic phospholipase C genes. The nucleotide sequence of the C. albicans gene, CAPLC1 (2997 bp), was determined from a recombinant clone containing C. albicans 132A genomic DNA; it encoded a polypeptide of 1099 amino acids with a predicted molecular mass of 124.6 kDa. The deduced amino acid sequence of this polypeptide (CAPLC1) exhibited many of the features common to previously characterized PLCs, including specific X and Y catalytic domains. The CAPLC1 protein also exhibited several unique features, including a novel stretch of 18-19 amino acid residues within the X domain and an unusually long N-terminus which did not contain a recognizable EF-hand Ca(2+)-binding domain. An overall amino acid homology of more than 27% with PLCs previously characterized from Saccharomyces cerevisiae and Schizosaccharomyces pombe suggested that the CAPLC1 protein is a delta-form of phosphoinositide-specific PLC (PI-PLC). PLC activity was detected in cell-free extracts of both yeast and hyphal forms of C. albicans 132A following 7 h and 24 h growth using the PLC-specific substrate p-nitrophenylphosphorylcholine (p-NPPC). In addition, CAPLC1 mRNA was detected by reverse transcriptase PCR in both yeast and hyphal forms of C. albicans 132A at the same time intervals. Expression of CAPLC1 activity was also detected in extracts of Escherichia coli DH5 alpha harbouring plasmids which contained portions of the CAPLC1 gene lacking sequences encoding part of the N-terminus. Southern hybridization and PCR analyses revealed that all C. albicans and Candida dubliniensis isolates examined possessed sequences homologous to CAPLC1. Sequences related to CAPLC1 were detected in some but not all isolates of Candida tropicalis, Candida glabrata and Candida parapsilosis tested, but not in the isolates of Candida krusei, Candida kefyr, Candida guillermondii and Candida lusitaniae examined. This paper reports the first description of the cloning and sequencing of a PLC gene from a pathogenic yeast species.