Diet drinks and dental caries among U.S. adults: cluster analysis.

BACKGROUND: In recent years, the consumption of sugar sweetened beverages has been declining, while low calorie sweetener and diet beverage consumption is increasing. Evidence about the effect of diet drinks on dental caries is insufficient, and has not accounted for the complexity of beverage consumption patterns. Therefore, the aim of this study is to examine the association between consuming diet drinks and dental caries among US adults. METHODS: We analyzed 2011-2014 NHANES dietary data of adults using cluster analysis, with individuals grouped based on their beverage consumption. Clusters were identified based on the R-square statistic and the local peak of the pseudo F statistic. Survey procedure and sample weights were used to account for the complex NHANES sampling design. RESULTS: Four beverage consumption patterns were identified: "high soda", "high diet drinks", "high coffee/tea" and "high water". The "High soda" cluster was the only one associated with higher DMFT after controlling for confounders (ß=1.02, 95% CI=0.42 - 1.63), whereas DT was associated with "high soda" (ß=0.45, 95% CI=0.25 - 0.64) and "high coffee/tea" (ß=0.24, 95% CI=0.01 - 0.47). On the other hand, the "high diet drinks" cluster was neither associated with DMFT (ß=0.69, 95% CI=0.51 - -0.35) nor DT (ß=0.07, 95% CI=-0.21 - 0.35). CONCLUSION: Diet drinks consumption may not be associated with increased risk of dental caries. However, more studies should be conducted in order to confirm this finding.

Dental Erosion: Effect of Diet Drink Consumption on Permanent Dentition.

OBJECTIVE: The aim of this study is to examine the effect of diet drinks on dental erosion among a representative sample of US adults. METHODS: Adult dietary and dental data were analyzed from the 2003-2004 cycle of the National Health and Nutrition Examination Survey. Erosion was measured with a modified tooth wear index and was analyzed as a dichotomous variable. Cluster analysis was performed, and the cluster number was based on having a separate diet drink cluster and the R2 values. Survey procedure and sample weights were used. RESULTS: Most of the population (80%) had some form of dental erosive lesions. When compared with the total sample, people with erosion were more likely to be male (52.5%) and older. People with no erosive lesions were younger (42.3%) and non-Hispanic Black (21.2%). Cluster analysis resulted in 4 distinct clusters: high water, high diet drinks, high coffee/tea, and high soda. The respective percentage of individuals in each cluster who had erosion was 78.9%, 85%, 83.9%, and 76.2%, where the "high diet drinks" cluster showed the highest erosion (P = 0.28). Logistic regression modeling showed that the "high diet drinks" cluster had increased odds of erosion (odds ratio = 1.27; 95% CI = 0.58 to 2.77) when compared with the "high water" cluster, but the relationship was not statistically significant. CONCLUSION: High diet drinks consumption slightly increased the odds of dental erosion among US adults, although this relationship was not statistically significant. It is thus not yet clear that dentists should recommend diet drinks, as they might be linked to systemic diseases. Further research is needed to explore more about risk factors of erosion. KNOWLEDGE TRANSFER STATEMENT: The findings of this study are suggestive, though not significantly, that diet drinks may increase risk for dental erosion. While further research is needed, it is not clear that dentists should recommend these drinks as healthy substitutes for sugary drinks.

Phenotypic characterization of KCTD3-related developmental epileptic encephalopathy.

The association between KCTD3 gene and neurogenetic disorders has only been published recently. In this report, we describe the clinical phenotype associated with 2 pathogenic variants in KCTD3 gene. Seven individuals (including one set of monozygotic twin) from 4 consanguineous families presented with developmental epileptic encephalopathy, global developmental delay, central hypotonia, progressive peripheral hypertonia, and variable dysmorphic facial features. Posterior fossa abnormalities (ranging from Dandy-Walker malformation to isolated hypoplasia of the cerebellar vermis) were consistently observed in addition to other variable neuroradiological abnormalities such as hydrocephalus and abnormal brain myelination. One patient also had a multicystic kidney. Whole exome sequencing revealed 2 probably pathogenic homozygous variants in KCTD3 gene that fully segregated with the disease. KCTD3 gene belongs to a family of accessory subunits that regulate the biophysical properties of ion channels, and is highly expressed in the kidney and brain. In this largest series to date on KCTD3-mutated patients, we show that biallelic loss of function mutations in KCTD3 lead to a consistent phenotype of developmental epileptic encephalopathy and abnormal cerebellum on brain imaging.

Expanding the phenotype of SLC25A42-associated mitochondrial encephalomyopathy.

SLC25A42 gene encodes an inner mitochondrial membrane protein that imports Coenzyme A into the mitochondrial matrix. A mutation in this gene was recently reported in a subject born to consanguineous parents who presented with mitochondrial myopathy with muscle weakness and lactic acidosis. In this report, we present 12 additional individuals with the same founder mutation who presented with variable manifestations ranging from asymptomatic lactic acidosis to a severe phenotype characterized by developmental regression and epilepsy. Our report confirms the link between SLC25A42 and mitochondrial disease in humans, and suggests that pathogenic variants in SLC25A42 should be interpreted with the understanding that the associated phenotype may be highly variable.

Strongyloidiasis colitis: a case report and review of the literature.

A case is described of a nonimmunocompromised man who presented with diarrhea, weight loss, and microcytic anemia. Colonoscopy revealed a pancolitis characterized by aphthoid ulceration on endoscopy and intense tissue eosinophilic infiltrates on biopsy. Both colonic biopsies and stool aspirates revealed the larvae of Strongyloides stercoralis, thus confirming this parasite as the causative agent for the colitis.

Mint prevents shamma-induced carcinogenesis in hamster cheek pouch.

Shamma, a complex mixture of powdered tobacco, slaked lime, ash, oils, spices and other additives, has been linked to oral cancer in Saudi Arabia. Shamma varies in colour and odour due to the nature of the additives which characterize different brands. Using the Ames Salmonella assay, a chloroform extract of a brand named 'white shamma' (WSH) was found to be mutagenic, while that of a brand called 'brown shamma' (BSH), which is known to contain mint as a flavouring agent, was found to be non-mutagenic. Using HPLC, a mutagenic and a non-mutagenic fraction were isolated from the extract of BSH. The non-mutagenic fraction of BSH was found to neutralize the genotoxic effect of the mutagenic fraction when the two were recombined. A chloroform extract of mint showing no mutagenic activity in the Ames assay effectively inhibited the mutagenicity of carcinogens/mutagens like benzo[a]-pyrene, aflatoxin B1, methylmethane sulfonate and extract of WSH. A carcinogenicity assay designed to test the effects of WSH and BSH in the hamster cheek pouch model showed that the former was tumorigenic, while the latter was not. However, when crushed leaves of mint were mixed with powdered WSH (in 1:1 proportion), the tumorigenic effect of the latter was abolished. These data strongly suggested that mint has a chemopreventive effect against shamma-induced carcinogenesis, which could be due to its antimutagenic properties.

Hemorrhage after pancreatoduodenectomy.

OBJECTIVE: The authors reviewed the hemorrhagic complications of patients who underwent pancreatoduodenectomies between 1972 and 1996. SUMMARY BACKGROUND DATA: Although recent studies have demonstrated a reduction in the mortality of pancreatic resection, morbidity is still high. Bleeding is a close second to anastomotic dehiscence in the list of dangerous postoperative complications. METHODS: The medical records from a prospective data bank of 559 patients who underwent pancreatic resection at the Surgical Clinic of Mannheim (Heidelberg University) were analyzed in regard to postoperative hemorrhagic complications. Differences were evaluated with the Fisher exact test. RESULTS: The overall mortality rate was 2.7%. Postoperative bleeding occurred in 42 patients (7.5%), with 6 episodes ending fatally (14.3%). Erosive bleeding after pancreatic leak was noted in 11 patients (26.2%), 4 of whom died. Gastrointestinal hemorrhage occurred in 22 patients, and operative field hemorrhage was present in 20 cases. Relaparotomy was necessary in 29 patients. An angiography with interventional embolization for recurrent bleeding was performed in three patients. Seven hemorrhages (4.6%) occurred after pancreatectomy for chronic pancreatitis and 35 episodes of bleeding (8.6%) were encountered after pancreatectomy for malignant disease. Obstructive jaundice was present in 359 patients (63.9%). In this group of patients, 32 (8.9%) postoperative hemorrhages occurred. Preoperative biliary drainage did not influence the type and mortality rate of postoperative hemorrhage in jaundiced patients. CONCLUSION: The prevention of these bleeding complications depends in the first place on meticulous hemostatic technique. Preoperative biliary drainage does not lower postoperative bleeding complications in jaundiced patients. Continuous, close observation of the patient in the postoperative period, so as to detect complications in time, and expeditious hemostasis are paramount.

Hepatic iron overload associated with self-medication.

A patient with the incidental finding of an elevated serum ferritin level was found to have hepatic iron overload associated with iron injections. Liver disease is an example of one of the potential complications of folk remedies or patient self-medication that physicians may encounter, especially along the US-Mexican border.

In vivo skin elasticity of 22 anatomical sites: The vertical gradient of skin extensibility and implications in gravitational aging.

BACKGROUND/AIMS: Regional anatomical variations in bio-mechanical properties of skin were not mapped systematically in the past, despite the obvious clinical variation of this function. The object was to describe variations in skin distensibility and elasticity by the use of a suction chamber device. METHODS: 22 different anatomical sites were measured in 25 healthy volunteers aged 5-72 years. Anatomical sites were numbered systematically from the head toward the foot according to a vertical principle as a part of the study design. RESULTS: A systematic and vertically oriented decrease of distensibility and hysteresis from the head toward the foot was observed with a gradual increase of skin stiffness toward the ground. Skin elasticity decreased significantly with age. Acral female skin was more easily distended than male skin. CONCLUSIONS: The vertical gradient of skin distensibility was described for the first time. This appears a prerequisite to resist the hydrostatic pressure and influences of gravity. The findings may have important implications in leg ulcer and gravitational syndrome.

Bacterial bronchitis and bronchiectasis in human immunodeficiency virus infection.

BACKGROUND: Bacterial pneumonia and sinusitis are important causes of morbidity in patients with human immunodeficiency virus (HIV) infection. We noted an increased incidence of bacterial bronchitis and bronchiectasis in our patients with HIV infection. METHODS: This study was conducted on persons with HIV infection at a county hospital and clinic. Bronchiectasis was diagnosed by bronchogram and computed tomography in one patient and by computed tomography alone in two others. Bacterial bronchitis was defined by a Gram's stain showing an abundance of neutrophils with a predominance of one or more bacteria and by a confirmatory sputum culture. Bronchoscopy with broncho-alveolar lavage was performed in patients with bronchitis to eliminate other causes of bronchial inflammation. RESULTS: Eighteen episodes of bacterial bronchitis in 10 patients are described. The mean CD4 lymphocyte counts for these patients was 0.061 x 10(9)/L (range, 0.001 to 0.203 x 10(9)/L). The most common pathogens in 18 episodes of bacterial bronchitis were Haemophilus influenzae and Streptococcus pneumoniae (five episodes each) and Pseudomonas aeruginosa (four episodes). Response to antibiotic therapy was usually rewarding though recurrences were frequent. Three patients with well-defined bronchiectasis who appeared to have developed, or who became symptomatic during the course of, HIV infection are described. Their mean CD4 cell count was 0.03 x 10(9)/L (range, 0.024 to 0.037 x 10(9)/L). Haemophilus influenzae, Staphylococcus aureus, Pseudomonas cepacia, and P aeruginosa were recovered from these patients; the P aeruginosa was a mucoid strain. CONCLUSIONS: Recurrent bacterial bronchitis should be added to the list of bacterial infections that occur with increased frequency with HIV infection. Repeated bacterial bronchitis may lead to bronchiectasis, which may be more common in HIV infection than generally appreciated.

Granulomatous gastroenteritis. Case report with comparison to idiopathic isolated granulomatous gastritis.

A woman with epigastric pain, vomiting, weight loss, and an upper gastrointestinal series showing antral rigidity suggestive of linitis plastica was found to have granulomatous inflammation of the stomach. Additional investigations disclosed more extensive gastrointestinal involvement, with noncaseating granulomas found in esophageal and colonic mucosa, despite normal appearances at endoscopy. Intestinal permeability to [51Cr]EDTA was increased, suggesting intestinal mucosal injury. No specific entity, including disseminated sarcoidosis or Crohn's disease, was diagnosed. This patient with granulomatous gastroenteritis had a clinical and histologic response to medical therapy with prednisone and recurrence of symptoms when prednisone was tapered. Her clinical course was similar to that of previous cases of idiopathic isolated granulomatous gastritis treated nonsurgically. Cases of idiopathic isolated granulomatous gastritis should be categorized as such only if a thorough evaluation has been performed to determine extent of disease, as well as to exclude other entities.

Cerebral arterial thrombosis as a complication of paroxysmal nocturnal hemoglobinuria.

Venous thrombosis is a frequent complication in patients with paroxysmal nocturnal hemoglobinuria (PNH). However, arterial thrombosis is rare, and cerebral arterial thrombosis has been reported only in postmortem studies. We discuss the case of a PNH patient in whom both clinical and neuroimaging findings were compatible with cerebral arterial and venous thrombosis.

[The questions of international migration]. / Les questions de migrations internationales.

PIP: International migrations have growing implications for both countries of destination. In the latter, the presence of foreigners and of members of their families today creates problems of integration, causes argument, and brings mounting xenophobia. Paralleling political, economic, and social measures taken by public authorities to respond to these difficulties, education needs to assist in diffusing the resulting social tensions by preparing the minds of learners and helping to develop new attitudes. In particular, when educational programs address questions of international migration, these should be treated in the framework of historical evolution in order that their real significance and their true temporal and spatial dimensions become apparent. It is also important that the growing interdependence between countries should be made plain, that national history should be placed in its international context, and that the true consequences of these developments should be made clear. In this context, learners need to be acquainted with Human Rights, thereby stressing universal moral values and the role of the individual. Lastly, questions relating to international migration are usually presented in the media in a selective and partial manner, and the young people who take in this information often accept the hasty judgments which are made of situations as proven facts. This is why all teaching about international migration needs to be considered or reconsidered in light of the complementary or competing actions of the media. (author's modified)^ieng

[Economic activity of Third World women and perspectives on the decline of their fertility]. / Activite economique des Femmes du Tiers Monde et perspectives de baisse de leur fecondite.

PIP: Despite recent efforts to achieve a better understanding of the economic roles of women throughout the world, progress has been impeded by the lack of available statistical material concerning their employment. The importance of women's productive activity remains unrecognized in most of the Third World because it is largely accomplished outside the cash sector and is not included in any statistics. 72% of women in developing countries live in rural zones, where they are occupied in production, processing, storage, and preparation of foodstuffs. Many also assist the family budget by selling foodstuffs and craft products. The role of women in agriculture and commerce varies in different regions; it is estimated that 60-80% of agricultural labor in Africa and about 40% in Latin America is female. Third World women have also found employment in labor intensive industries such as electronics and textiles. The active female population grew from 1950-75 at 2.5%/1year in Asia, 1.9% in Africa, and 3.2% in Latin America. Major variations are seen in the female participation rates of countries within the same regions. The number of women working in the nonorganized sector is not known. Particularly in cities, most new jobs have been in the service sector. Prior to the spread of the capitalist mode of production, the productive and reproductive roles of women were equally significant and compatible, and women had a greater weight in family and community. With the separation of the cash and subsistence sectors, women were increasingly relegated to the least prestigious and least remunerative sectors. When forced to seek work in the modern sector, their lack of education and the persistence of traditional sexist practices allowed them to find only the least qualified, most poorly paid, and least secure jobs in the primary, secondary, or tertiary sectors. The introduction of technical development into Third World countries benefitted women very little, since it was usually addressed only to men. Although migration for many women had a fertility dampening effect, for many others it reinforced their attachment to reproductive traditions. The maintenance of high levels of fertility among Third World women, despite their participation in paid labor, can be explained in part by tradition and religious values and productive roles of children, but also by dissatisfaction with the low level employment conditions available to them.^ieng