Initial bone preparation followed by a 2-week delay before implant placement enhances the clinical and radiographic outcome: a randomized controlled trial.

Initial bone preparation followed by a 2-week delay before implant placement enhances the biological activity at the osteotomy site, which may improve the treatment outcome. The aim of this study was to compare the clinical and radiographic outcomes of initial bone preparation and a 2-week delay in implant placement with the conventional method. Subjects were outpatients selected from a department of periodontology and oral implantology. The implant sites were randomly allocated to a test group and a control group (n=7 each). Test sites were treated with initial bone preparation followed by implant placement after a 2-week delay; control sites were treated with the conventional protocol. All sites were assessed over 12 months for the keratinized mucosa index, probing depth, implant mobility, and radiographic peri-implant crestal bone levels. A total of 14 implants were placed in 12 subjects (five males and seven females, mean age 31.5 years, range 18-45 years). The results showed a statistically significant reduction in peri-implant probing depth and crestal bone levels in the test group (P<0.01). This randomized controlled trial demonstrated better clinical and radiographic outcomes for initial bone preparation followed by a 2-week delay in implant placement; this may be an alternative to the conventional protocol.

Surveys of rice sold in Canada for aflatoxins, ochratoxin A and fumonisins.

Approximately 200 samples of rice (including white, brown, red, black, basmati and jasmine, as well as wild rice) from several different countries, including the United States, Canada, Pakistan, India and Thailand, were analysed for aflatoxins, ochratoxin A (OTA) and fumonisins by separate liquid chromatographic methods in two different years. The mean concentrations for aflatoxin B(1) (AFB(1)) were 0.19 and 0.17 ng g(-1) with respective positive incidences of 56% and 43% (≥ the limit of detection (LOD) of 0.002 ng g(-1)). Twenty-three samples analysed in the second year also contained aflatoxin B(2) (AFB(2)) at levels ≥LOD of 0.002 ng g(-1). The five most contaminated samples in each year contained 1.44-7.14 ng AFB(1) g(-1) (year 1) and 1.45-3.48 ng AFB(1) g(-1) (year 2); they were mostly basmati rice from India and Pakistan and black and red rice from Thailand. The average concentrations of ochratoxin A (OTA) were 0.05 and 0.005 ng g(-1) in year 1 and year 2, respectively; incidences of samples containing ≥LOD of 0.05 ng g(-1) were 43% and 1%, respectively, in the 2 years. All positive OTA results were confirmed by LC-MS/MS. For fumonisins, concentrations of fumonisin B(1) (FB(1)) averaged 4.5 ng g(-1) in 15 positive samples (≥0.7 ng g(-1)) from year 1 (n = 99); fumonisin B(2) (FB(2)) and fumonisin B(3) (FB(3)) were also present (≥1 ng g(-1)). In the second year there was only one positive sample (14 ng g(-1) FB(1)) out of 100 analysed. All positive FB(1) results were confirmed by LC-MS/MS.

Randomized prospective study of outcome of short term antiepileptic treatment in small single enhancing CT lesion in brain.

The study was conducted in 81 patients of epilepsy with small single enhancing CT (SSECT) lesion in brain to determine the clinical profile and duration of antiepileptic drugs (AEDs) treatment. The patients were randomly divided into group A (41 cases) and group B (40 cases). Group A patients were treated for 6 months and group B for 1 year with AEDS without cysticidal drugs. The most common mode of presentation was simple partial motor seizures with secondary generalization in both the groups. Repeat imaging of brain (CT/MRI) at 6 months showed disappearance of lesion in 82.94% in group A and 87% in group B, while persistence of lesion was present only in 4.87% in group A and 5% in group B. 87.81% patients in group A and 87.17% in group B were seizure free. The recurrence of seizure occurred in 12.19% cases in group A, and 12.82% in group B. 80% of these patients had calcified lesion in both the groups. This study reveals that SSECT lesion with epilpesy is a benign self-limiting disease. It also reveals that 6 months AED treatment is as effective as one year treatment. Patients having calcified lesion or persistence of lesion might require long term AED treatment.

Topiramate: a new safe and effective antiepileptic.

Twenty patients of either sex, with refractory partial epilepsy with or without secondary generalisation were entered in an open label study to evaluate the efficacy and safety of topiramate in them. Topiramate was used as an adjunctive therapy with an initial starting dose of 50 mg/day. The dose was then titrated upwards with increments of 50 mg per week, till a time the most effective and the best tolerated dose was reached. This most effective/tolerated dose was then continued for 6 months. Of the 17 patients entering the maintenance phase, 4 patients (24%) became seizure free, while a total of 14 patients (83%) out of 17 cases responded with a reduction in monthly seizures rate by 50% or more. Mean reduction of 68.9% was observed in monthly seizure rate during the maintenance phase. The median effective dose of topiramate was 600 mg per day. Five patients dropped out of the study due to adverse events such as anxiety, aggressiveness, rash, lethargy, etc. The central nervous system (CNS) related side effects such as dizziness, headache, and tremor were reported, which are commonly seen with other presently available antiepileptics like carbamazepine, phenytoin sodium, sodium valproate, etc, as well. Most adverse events, however, were mild and transient and did not interfere with the day to day activity of the patients. Topiramate was not associated with any abnormality in laboratory or neurological examination findings. The excellent response with topiramate therapy in Indian patients, uncontrolled with the available antiepileptics, as well as its good safety profile endorse the international efficacious and safe image of topiramate.

Hepatitis E virus infection in eastern India.

Most cases of enterically transmitted non-A, non-B hepatitis in India have so far been attributed to hepatitis E virus (HEV) infection. Most of the documented studies of hepatitis have focused on the incidence of this disease in northern, western, and south central India. A small seroprevalence study was conducted in the eastern Indian city of Patna to assess the degree of HEV infection among acute sporadic hepatitis cases. Forty-two percent (24 of 57) of the cases of acute sporadic hepatitis were positive for anti-HEV antibodies. Absence of any serologic markers of hepatitis A, B, or E in 58% (33 of 57) of the cases with symptoms of acute hepatitis suggest that there may be as yet unidentified enterically transmitted viruses in this area.

Predictor of outcome of hyperthyroidism due to Graves disease: serum triiodothyronine/thyroxine ratio.

There is a proportionally greater increase in the serum T3 than Serum T4 concentration in patients with hyperthyroidism due to Grave's disease which results in an elevation of serum T3 to T4 ratio. The study was undertaken to investigate the alteration of serum T3 to T4 ratio in relation to the outcome of antithyroid drug therapy. 98 patients of hyperthyroid Grave's disease were studied and 78 patients had T3 to T4 ratio greater than 20 ng/microgram before therapy (normal range 14-20; mean 16.0) In 16 out of 78 patient T3 to T4 ratio remained high during a 18 months course of antithyroid drug therapy and in 13 of them (81%) hyperthyroidism recurred after stoppage of treatment. In the remaining 62 patients, the initial high T3 to T4 ratio became normal (< 20) during treatment and 34 of them (54.9%) had a remission of the disease after stoppage of the drug. Of the 20 patients in whom the initial T3 to T4 ratios were within normal range, the ratio remained normal during treatment and 16(80%) had a remission. Goiter size was larger in patients with high serum T3 to T4 ratio and reduction of goiter size occurred in some patients (59%) with decreasing T3 to T4 ratios. It is concluded that serum T3 to T4 ratio is a single and a useful predictor of the outcome of antithyroid drug therapy in patients with hyperthyroidism due to Grave's disease. A ratio greater than 20 throughout therapy indicates that the chances of relapse is high and a ratio below 20 either initially or during therapy is an indication of prolonged remission.

Blood mercury in workers exposed to the preparation of mercury cadmium telluride layers on cadmium telluride base.

Study was conducted in a group of 32 persons engaged in liquid phase epitaxial growth of mercury cadmium telluride (MCT) layers for nearly 11 years. Airborne mercury concentrations in work environment have been exceeding the threshold limit value of 0.05 mg/m3 recommended by ACGIHD. Hg concentration in workplace during peak working hours remained between 0.04-0.08 mg/m3. Findings were compared with 32 unexposed referents. Mercury value was estimated 1.60 +/- 0.20 (mean +/- SD) in control, and in Phase I and II, 10.72 +/- 1.34 ng Hg/ml and 8.08 +/- 1.15 ng Hg/ml of blood respectively. Results indicate a fall in blood mercury level during the second phase of study. But the values did not return to normal even after a gap of 3 months. An individual who met with a mercury accident showed 226 ng Hg/ml of blood which decreased to 25 ng/ml after 3 months. It is inferred from the present study that Hg level has increased significantly in MCT workers during working period, and also in non-working period, the values were higher than controls.

Seroprevalence of human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and rapid plasma reagin in a trauma population.

We evaluated the presence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and rapid plasma reagin (RPR) among patients admitted to our trauma unit from April 15 to June 30, 1993. Of 984 patients tested, we found 255 (26%) had evidence of exposure to one or more of these agents: HIV, 4%; HBV, 20%; HCV, 14%; and RPR, 1%. Thirty-eight percent of patients had more than one positive serology, 75% of the HIV patients, 49% of the HBV patients, and 66% of the HCV patients. There was no difference between penetrating and nonpenetrating trauma with respect to any of the viruses. The risk factors for HIV-positive patients were non-White race, positive drug screen, positive alcohol screen, and city resident. Risk factors for HBV patients were non-White race, positive drug screen, and city resident. Risk factors for HBC patients were male sex, non-White race, positive alcohol screen, positive drug screen, and city resident. The risk of blood-borne infections in this group of patients is substantial.

Application of commercial assays to detect IgG antibodies to hepatitis C virus in urine: a pilot study from autopsy cases.

Hepatitis C virus (HCV), the main cause of non-A, non-B hepatitis in the United States and possibly in the world, is believed to be transmitted primarily through parenteral exposure. Many screening and supplemental tests are available to detect antibodies to HCV in serum. The ability to use commercial assays to detect antibodies to HCV in urine was investigated in this study. A total of 229 serum/urine matched samples were collected sequentially from forensic autopsy cases examined at the Office of the Chief Medical Examiner, State of Maryland. Testing was performed using the Ortho, Innogenetics, and Abbott second generation HCV screening tests and the INNO-LIA HCV Ab supplemental assay. Sample volumes were increased for urine testing. Forty-six of 229 serum samples were positive by screening and confirmed by supplemental tests. The urine samples produced positive results on 44-45 of the same 46 by screening tests and all 46 positives by the supplemental test. There were no false positive samples using urine when compared with the serum pairs. The one false negative sample using urine was still nonreactive when the urine volume was increased to 200 microliters using the screening tests. Generally, five times the serum volume was required for the screening tests to be optimal for urine samples. The urine samples were stored under different conditions prior to testing to determine the influence on antibody stability in urine.

Enhanced chemiluminescence as a means of increasing the sensitivity of western blot assays for HIV antibody.

Chemiluminescence indicator systems offer several advantages for diagnostic assays and have been used successfully to increase the sensitivity of antibody and antigen assays. A technique of enhanced chemiluminescence (ECL) was applied as a replacement for routine chromogenic substrates on HIV-1 Western blots. The results indicated that the enhanced chemiluminescence detection system increased the sensitivity by greater than 10-fold over routine chromogenic indicator systems when testing diluted, reactive sera. When testing 9 seroconversion panels, the use of ECL indicated that early detection of HIV infection was elicited in six panels up to 31 days (average 11.4 days) prior to detection by routine FDA-licensed Western blots, and could be detected in all panels up to 43 days (average 18.8 days) prior to detection by in-house Western blots. In no case was the ECL Western blot system less sensitive than any of the chromogenic Western blots, and in several cases the maximum potential of the ECL system for early detection of antibody could not be determined. The ECL system was capable of detecting antibodies to envelope antigens at a 20-fold increase over chromogenic Western blots. The time of detection of seropositivity by the ECL Western blot was equal to that of most ELISAs in 5 panels and was 31 days earlier than ELISA in one panel. Permanent documentation of Western blot profiles was accomplished using a simple instamatic camera system capable of detecting the chemiluminescence signal, and blots could be re-probed using a second sample.(ABSTRACT TRUNCATED AT 250 WORDS)

Application of a rapid assay for detection of antibodies to human immunodeficiency virus in urine.

The use of rapid, simple tests to detect antibodies to human immunodeficiency virus (HIV) in urine could be valuable for several testing situations, such as in private offices, for epidemiologic surveys, and in developing countries. The authors evaluated the performance of the SUDS HIV type 1 test to detect antibody to HIV-1 peptides in urine. Test performance and applicability of the SUDS test were compared with a routine Food and Drug Administration-licensed enzyme-linked immunosorbent assay (ELISA) and Western blot using 139 serum and urine pairs collected from autopsy cases. Using a modified procedure when testing urine by the SUDS test, results indicated that a total of 15 serum/urine pairs were HIV-1 antibody positive by both the SUDS test and ELISA; all could be confirmed positive by Western blot. One sample produced discrepant results. The SUDS test produced no false-positive results when testing serum or urine, as compared with ELISA, and no false-negative results when compared with the Western blot. For optimal accuracy of detection of antibodies using urine, at least 100 microL of sample was required. By Western blot analysis, antibody profiles in urine were generally weaker than in serum, but confirmation of positivity was not compromised when larger volumes were used. The authors concluded that this rapid HIV-1 test, when used to detect antibodies to HIV-1 in urine, is accurate, easy to perform, and appropriate for use in certain testing situations.

Second generation hepatitis C virus assays: performance when testing African sera.

Sera were collected from 426 volunteers in Uganda at high and low risk for acquisition of hepatitis C virus (HCV). All samples were tested by the Ortho HCV second generation ELISA (S1) and by the INNOTEST HCV Ab second generation enzyme immunoassay, (S2), (Innogenetics, Antwerpen, Belgium). Sera that were repeatedly reactive by either screening assay were further tested by each of two different HCV supplemental/confirmatory assays: a second generation recombinant immunoblot assay (RIBA, Ortho Diagnostics), (C1), and a line immunoassay (INNO-LIA HCV-Ab, Innogenetics), (C2). In these populations there were 16 true positives, 351 true negatives, and 59 indeterminate results. Fifty-nine point four percent (253/426) of the samples were repeatedly reactive by the S1 test, while only 2.6% (11/426) were repeatedly reactive by S2. Test S1 produced a high false positive rate, a low positive predictive value, a specificity of 49.3%, and had a sensitivity of 100%. In contrast, the S2 screening assay had much higher specificity (98.8%), but lacked in sensitivity (31.3%). This poor sensitivity of S2 was based almost exclusively on the fact that the C2 supplemental test classified 9 samples as confirmed positive when the homologous screening assay classified these samples as negative; several of these were not confirmed when using a new generation INNO-LIA. Both the screening tests S1 and S2, and the supplemental assays C1 and C2 exhibited a significant degree of discordance, and neither of the screening tests alone would be adequate for use in these populations.

Evaluation of five hepatitis C virus screening tests and two supplemental assays: performance when testing sera from sexually transmitted diseases clinic attendees in the USA.

The performances of five screening tests (recombinant peptide-based first and second generation tests from Abbott and Ortho, and a synthetic peptide-based test from Biochem Immunosystems) and two supplemental tests: recombinant peptide- based, Abbott neutralization test and Chiron second generation recombinant immunoblot assay (RIBA 2), were evaluated for their ability to detect hepatitis C virus (HCV) antibodies in a population of 276 individuals attending a sexually transmitted diseases (STD) clinic in the USA. Although the five screening tests produced a variable number (35-62) of repeatedly reactive samples, only 13% (36/276) were classified as true positives by the supplemental tests. Thirty-four of the 36 were reactive by all screening tests and 32 of the true positives were reactive by both supplemental tests, while 2 did not neutralize but were reactive in the RIBA 2 test. Of the remaining 2 of the true positives which were discordant by several of the screening assays, 1 was confirmed by both supplemental assays but the other required a chemiluminescent enhancement technique to show positivity in RIBA 2. The sensitivities of the first and second generation Abbott and Ortho tests ranged from 97% to 100% and that of the Biochem test was 94%. The specificities of these tests ranged from 89.2% to 99.6%. The second generation Ortho test presented 9.4% (26/276) false positives. The use of second generation Ortho as a screening test would lead to an excessive number of confirmatory false positives. the positive predictive values of the screening tests ranged from 58.1% to 97.1%. Although the synthetic peptide based Biochem test exhibited the best overall indices, the presence of 2 false negative results would prevent its use as a singular screening test. Nevertheless its high specificity may lend itself to be used as a second screening test before confirmatory testing with RIBA 2.

Multiple blood-borne and sexually transmitted infections in sexually transmitted disease clinic and hospital emergency room patient populations.

The degree of coinfections with blood-borne or sexually transmitted pathogens (HIV-1, HTLV-I/II, HBV, HCV, HDV, and Treponema pallidum) were assessed in individuals attending sexually transmitted diseases (STD) clinic and patients admitted to a hospital through the emergency room in Baltimore. Enzyme-linked immunosorbent assays (ELISA), immunoblots, and card tests were used to screen the sera. Nearly one third of the individuals in both populations were infected with one or more pathogens. With some minor exceptions, all individuals with dual or multiple infections had antibodies reactive with the HBV core antigen. There was a strong overall association between the presence of antibodies to HIV-1 and the presence of antibodies to HBV core and HCV in both populations. Additionally, the presence of HIV-1 antibodies was significantly associated with the presence of HTLV-I/II antibodies and HBV surface antigen in the STD population and with a positive RPR test result in the H/ER population. We suggest that HIV-1 and/or HTLV-I/II infected individuals in STD clinic and emergency rooms are highly likely to have had past infections with HBV or HCV.