Impact of untreated dental caries and dental pain on sadness related to oral health of Brazilian children.

PURPOSE: Children should feel sad when they believe that a negative outcome is permanent. The sadness that an oral problem might bring tends to contribute to children's loneliness and increase the social stress levels. The aim of this study was to evaluate the impact of untreated dental caries, dental pain, malocclusion, and traumatic dental injury on prevalence of sadness related to oral health among Brazilian children. METHODS: This cross-sectional study was carried out with 397 children aged 8-10 years randomly selected from public and private schools in Diamantina, Brazil. The Brazilian version of the CPQ8-10 was applied. Sadness was collected through the question, "In the last month how often did you feel sad because of your teeth or mouth?" and dental pain through the question, "In the last month, how many times have you had pain in your teeth?" One calibrated examiner (Kappa value intra examiner: 0.77-0.91; Kappa value inter examiner: 0.80-1.00) performed the exam for dental caries (DMFT), malocclusion (DAI), and dental trauma (O'Brien). Parents answered questions addressing socioeconomic issues. Descriptive analyses, Chi-square test, and hierarchical Poisson regression models were performed (IC 95%; p < 0.05)." RESULTS: The prevalence of sadness related to oral health was 30.5% (n = 121). Sadness related to oral health was associated with untreated dental caries (PR: 1.46; 95% CI 1.32-2.46; p = 0.001 ) and dental pain (PR: 2.91; 95% CI 2.00-4.22; p < 0.001). Other clinical variables analyzed (traumatic dental injury and malocclusion) were not significantly associated with sadness related to oral health. CONCLUSIONS: Children with untreated dental caries and dental pain presented a higher report of sadness related to oral health.

Vaccinia virus detection in dairy products made with milk from experimentally infected cows.

Vaccinia virus (VACV) is the agent of bovine vaccinia (BV), an emerging zoonosis that causes exanthematic lesions on the teats of dairy cows and on the hands of milkers. The virus has been detected in the milk of naturally infected cows. The objective of this study was to investigate and quantify VACV DNA as well as the presence of infectious virus particles in samples of cheese curd, cheese whey and pasteurized milk produced using milk from cows experimentally inoculated with VACV-GP2, a Brazilian isolate of VACV (VACV-BR). VACV DNA was detected in samples of cheese and pasteurized milk at different time points, even after the resolution of the typical lesions caused by VACV, which occurred after 22 days post-infection (dpi), on average. Moreover, it was possible to detect infectious viral particles in cheese samples on alternate days until 27 dpi. The presence of both VACV DNA and infectious viral particles in cheese samples throughout the clinical course of BV and even after the disappearance of the typical clinical signs of disease draws attention to the risk associated with consumption of the cheese. Furthermore, VACV-contaminated milk and cheese may represent an occupational risk to cheesemakers who often manipulate milk and cheese curd without wearing gloves.

Mesenteric lymph node granulomatous lesions in naturally infected wild boar (Sus scrofa) in Portugal--Histological, immunohistochemical and molecular aspects.

Several studies have demonstrated that wildlife reservoirs of mycobacteria are responsible for the maintenance and spreading of the infection to livestock and wildlife counterparts. Recent data report the role of wild boar (Sus scrofa) as a reservoir for Mycobacterium bovis. This study was conducted to evaluate the chronic inflammatory response in the mesenteric lymph nodes (MLN) of wild boar with granulomatous lymphadenitis (n=30). Morphological parameters of the lesions were recorded. The expression of CD3 and CD79α molecules was evaluated by immunohistochemistry. Molecular genotyping and culture to identify mycobacteria were performed. The lesions consisted mainly of stage III and stage IV granulomas. CD3 and CD79α positive cells were observed in 15 (50%) and in 11 (36.6%) MLN, respectively. In these lesions, higher percentages of T lymphocytes were found and a limited number of animals exhibited a tendency for an increased percentage of B lymphocytes. Our results suggest that there are similar percentages and distribution patterns of CD3 and CD79α in the lesions, regardless of the presence of Mycobacterium avium subsp. paratuberculosis (Map), M. bovis or Map-M. bovis co-infection, and confirm that wild boar is both susceptible and could be an important Map and M. bovis wild reservoir in the study area.

New Insights into Mycobacterium bovis Prevalence in Wild Mammals in Portugal.

A survey to determine the prevalence of Mycobacterium bovis in wild mammals in Portugal was conducted by testing samples from hunted animals and those found dead between 2009 and 2013. In this study, we investigated 2116 wild mammals. Post-mortem examinations were performed, and tissues were collected from wild mammals representing 8 families and 11 different species, with a total of 393 animals analysed. Cultures were performed, and acid-fast isolates were identified by PCR. Tissues were also screened for Mycobacterium bovis by directly extracting DNA and testing for the Mycobacterium bovis-specific sequences. Mycobacterium bovis prevalence was 26.9% (95% CI: 22.8-31.5%). Mycobacterium bovis was recorded in 106 of the 393 studied species: prevalence by species were 26.9% (95% CI: 16.8-40.2%) in red foxes, 20.0% (95% CI: 7.0-45.2%) in Egyptian mongooses, 21.4% (95% CI: 16.2-27.7%) in wild boar and 38.3% (95% CI: 29.9-47.4%) in red deer. Mycobacterium bovis infection was detected in six of eight taxonomic families. For some species, the small sample sizes obtained were a reflection of their restricted range and low abundance, making estimates of infection prevalence very difficult (1 beech marten of 4; 1 Eurasian otter of 3; 2 common genet of 3). Infection was not detected in European badgers, hedgehog, wild rabbits and hare. The results of this study confirm the presence of Mycobacterium bovis infection in wild carnivores in Portugal.

Combined C4d and CD3 immunostaining predicts immunoglobulin (Ig)A nephropathy progression.

A number of molecules have been shown recently to be involved in the pathogenesis and progression of immunoglobulin (Ig)A nephropathy (IgAN). Among these, we have selected C4d (complement lectin pathway involvement), CD3 (T cell marker, traducing interstitial inflammation), transglutaminase 2 (TGase-2, involved in tissue fibrosis development) and p-extracelluar-regulated kinase (ERK)1/2 (protein kinase intracellular signaling molecule) to perform a panel of immunohistological biomarkers and assess its predictive value for disease progression. Immunohistochemical staining of these biomarkers was performed in paraffin sections from 74 renal biopsy cases with the clinical diagnosis of IgAN. Association between score analysis of these parameters and disease course was assessed through univariate and multivariate analysis, including baseline clinical and histological data. Univariate analysis showed that glomerular C4d, tubulointerstitial TGase2 and CD3 scores were associated with baseline proteinuria and disease progression. Multivariate analysis showed that only baseline estimated glomerular filtration rate (eGFR), C4d and CD3 were associated independently with progressive kidney disease (decline of at least 50% in the eGFR or progression to end-stage renal disease (ESRD) during the follow-up period). Establishing an accurate prediction model for IgAN progression is still a matter of research in clinical nephrology. The complement system, particularly lectin pathway activation, and T cell activation, have been shown previously to be potential modifiers of the disease course. Here we show that the combination of two histological biomarkers (C4d and CD3) can be a powerful predictor of IgAN progression and a potential useful tool for the clinical approach of this disease.

Detection of Vaccinia virus in blood and faeces of experimentally infected cows.

Bovine vaccinia (BV), a zoonosis caused by Vaccinia virus (VACV), affects dairy cattle and milkers, causing economic, veterinary and human health impacts. Despite such impacts, there are no experimental studies about the pathogenesis of BV in cows to assess whether there is a systemic spread of the virus and whether there are different ways of VACV shedding. Trying to answer some of these questions, a study was proposed using experimental inoculation of VACV in cows. All experimentally infected cows developed lesions compatible with VACV infection in cattle. Two of the six animals presented VACV DNA in blood and faecal samples, starting at the 2nd and the 3rd day post-infection (d.p.i.), respectively, and lasting until the 36th d.p.i., in an intermittent way. This study provides new evidence that VACV can be detected in blood and faeces of infected cows, suggesting that BV could be a systemic disease, and also bringing new information about the epidemiology and pathogenesis of BV.

Comparison of long-term effect of thymoglobulin treatment in patients with a high risk of delayed graft function.

BACKGROUND: T-lymphocyte depletion is a strategy to reverse the impact of ischemia-reperfusion injury (IRI) in progression to chronic allograft dysfunction, especially among patients at high risk for delayed graft function (DGF). METHODS: The present work assessed the effect of thymoglobulin among a population with a high incidence of DGF. We analyzed 209 transplanted patients: 97 in the thymoglobulin and 112 in the control group. RESULTS: The main complication was DGF (59.3%), with a similar incidence in both groups (63.9% vs. 55.3%; P = .36). Acute rejection episodes (ARE) were decreased with thymoglobulin (8.2% vs. 28.5%; P < .001), but cytomegalovirus viremia was 3.4-fold more frequent (58.3% vs. 17.1%; P < .001). One-year graft function was significantly better in the thymoglobulin group (59.2 ± 17.2 vs. 51.8 ± 15.3 mL/min; P = .004), even when censored by ARE (59.7 ± 17.5 vs. 53.3 ± 14.4; P = .023). The same difference was observed at the 2-year follow-up (P = .024), even when censored for ARE (P = .045). A multivariate analysis showed thymoglobulin to be a factor strongly associated with protection of graft function (P = .039). CONCLUSION: Despite not reducing the incidence of DGF, thymoglobulin induction significantly reduced the incidence of ARE and showed a long-term profile of protection of renal graft function, independent of the reduction in ARE.

Effect of vitamin A supplementation on clinical evolution in patients undergoing coronary artery bypass grafting, according to serum levels of zinc.

Vitamin A and zinc are powerful antioxidants with synergy between them, thus protecting the organism against oxidative stress during the pre and postoperative periods. Our aim was to investigate the evolution clinical in patients undergoing coronary artery bypass grafting while receiving vitamin A supplements according to their zinc nutritional status. They were randomly divided into two groups (2:1): Control group (G1 = 60); and Supplemented group (G2 = 30) and subdivided according to the nutritional status of zinc. Serum concentrations of retinol, ß-carotene, zinc and levels of malondialdehyde were measured prior to (T0) and on the 21st day (T1) following surgery. After surgery, was found a significant difference between G1 and G2 when comparing retinol (G1 = 38.7 ± 17.1 µg/dL and G2 = 62.1 ± 20.3 µg/dL; p < 0.001) and ß-carotene (G1 = 12.3 ± 5.7 µg/dL and G2 = 53.5 ± 20.9 µg/dL; p < 0.001) in the patients with adequate concentrations of zinc. Analyzing the evolution clinical, operative mortality was 8.33% in G1 and 3.33% in G2. Hospitalization time significantly smaller in the G2 was found in the patients who had adequate concentrations of zinc (p = 0.001), as well as time in the intensive care unit both in those with adequate and inadequate levels of zinc (p = 0.047; p = 0.039). Such results may indicate that vitamin A supplementation may have a positive impact in combating the oxidative stress to which these patients are exposed above all in patients with adequate levels of zinc.

Anatomic variations in vascular and collecting systems of kidneys from deceased donors.

INTRODUCTION: Nephroureterectomy for transplantation has increased owing to the greater number of deceased donors. Anatomic variations may complicate the procedure or, if unrecognized, compromise the viability of kidneys for transplantation. METHODS: We reviewed 254 surgical descriptions of nephroureterectomy specimens from January 2008 to December 2009. All organs collected according by standard techniques were evaluated for age, cause of death, renal function, frequency of injury during the procedure, as well as variations in the vascular and collecting systems. RESULTS: The mean donor age was 42 years (range, 2-74). The mean serum creatinine was 1.2 mg/dL (range, 1.0-7.0). The causes of death were cerebrovascular cause (stroke; n = 130), traumatic brain injury (n = 81) or other cause (n = 43). Among the anatomic variations: 8.6% (n = 22) were right arterial anatomical variations: 19 cases with 2 arteries and 3 cases with 3 arteries. In 25 cases (9.8%) the identified variation was the left artery: 2 arteries (n = 23), 3 arteries (n = 1) and 4 arteries (n = 1). We observed 9.8% on right side and 1.5% on left side venous anatomic variations, including 24 cases with 2 veins on the right side and 4 cases with 2 veins on the left side. Three cases of a retroaortic left renal vein and 1 case of a retro necklace vein (anterior and posterior to the aorta). Two cases of ureteral duplication were noted on the left and 1 on the right kidney. There were 3 horseshoe and 1 pelvic kidney. In 7.5% of cases, an injury to the graft included ureteral (n = 3), arterial (n = 10), or venous (n = 6). CONCLUSION: The most common anatomic variation was arterial (17.8%). Duplication of the renal vein was more frequent on the right. The high incidences of anatomic variations require more attention in the dissection of the renal hilum to avoid an injury that may compromise the graft.

Effects of ischemia and reperfusion injury on long-term graft function.

BACKGROUND: The clinical manifestation of ischemia/reperfusion injury in renal transplantation is delayed graft function (DGF), which is associated with an increase in acute rejection episodes (ARE), costs, and difficulties in immunosuppressive management. We sought to evaluated the DGF impact after renal transplant. METHODS: We evaluated a group of 628 patients undergoing deceased donor renal transplantation between 2002 and 2005 at 3 Brazilians institutions to define the main DGF characteristics. RESULTS: DGF incidence was 56.8%, being associated with elderly donors (P = .02), longer time on dialysis (P = .001), and greater cold ischemia time (CIT; P = .001). Upon multivariate analysis, time on dialysis >5 years increased DGF risk by 42% (P = .02) and CIT >24 hours increased it by 57% (P = .008). In contrast, DGF was associated with an higher incidence of ARE: 27.7% in DGF versus 18.4% in IGF patients (P = .047). The ARE risk was 46% higher among individuals with DGF (P = .02), 44% among patients >45 years old (P < .001), 50% among those with >5 years of dialysis time (P = .02), and 47% lower among the who were prescribed mycophenolate instead of azathioprine (P < .001). Patients with DGF showed worse 1-year graft function (54.6 ± 20.3 vs 59.6 ± 19.4 mL/min; P = .004), particularly those with ARE (55.5 ± 19.3 vs 60.7 ± 20.4; P = .009). One-year graft survival was 88.5% among DGF versus 94.0% among non-DGF patients. CONCLUSION: The high incidence of DGF was mainly associated with a prolonged CIT. There was a relationship between DGF and ARE, as well as with a negative influence on long-term graft function.

Vimentin expression and myofibroblast infiltration are early markers of renal dysfunction in kidney transplantation: an early stage of chronic allograft dysfunction?

INTRODUCTION: The objective of this study was to show the morphologic characteristics of allograft renal biopsies in renal transplant patients with stable renal function, which can potentially be early markers of allograft dysfunction, after 5 years of follow-up. METHODS: Forty-nine renal transplant patients with stable renal function were submitted to renal biopsies and simultaneous measurement of serum creatinine (Cr). Histology was evaluated using Banff scores, determination of interstitial fibrosis by Sirius red staining and immunohistochemical study of proximal tubule and interstitial compartment (using cytokeratin, vimentin, and myofibroblasts as markers). Biopsies were evaluated according to the presence or absence of the epitheliomesenchymal transition (EMT). The interstitial presence of myofibroblasts and tubular presence of vimentin was also analyzed simultaneously. Renal function was measured over the follow-up period to estimate the reduction of graft function. RESULTS: Median posttransplant time at enrollment was 105 days. Patients were followed for 64.3 ± 8.5 months. The mean Cr at biopsy time was 1.44 ± 0.33 mg/dL, and after the follow-up it was 1.29 ± 0.27 mg/dL. Nine patients (19%) had a reduction of their graft function. Eleven biopsies (22%) had tubulointerstitial alterations according to Banff score. Seventeen biopsies (34%) presented EMT. Fifteen biopsies (32%) had high interstitial expression of myofibroblasts and tubular vimentin. Using Cox multivariate analysis, HLA and high expression of interstitial myofibroblasts and tubular vimentin were associated with reduction of graft function, yielding a risk of 3.3 (P = .033) and 9.8 (P = .015), respectively. CONCLUSION: Fibrogenesis mechanisms occur very early after transplantation and are risk factors for long-term renal function deterioration.

Effect of thymoglobulin in graft survival and function 1 year after kidney transplantation using deceased donors.

UNLABELLED: This study evaluated 1-year graft function and survival among kidney transplantations from deceased donors using thymoglobulin (Thymo) as an induction strategy. PATIENTS AND METHODS: Fifty-seven percent of patients were men and overall mean age was 42 +/- 15 years. Cold ischemia time was 20.1 +/- 4.8 hours. The primary outcome was defined as survival not censored for death after 1 year. The secondary outcome was defined as a comparison of function and survival among patients who received more or less then six doses of Thymo. RESULTS: Four patients experienced acute rejection episodes and the other three died during follow-up. One-year graft survival was 91% with a mean serum creatinine of 1.28 +/- 0.43 mg/dL. Cytomegalovirus infection occurred in 56%. Forty-two (64%) patients displayed acute tubular necrosis of mean duration of 6.89 +/- 7.48 days. Patients who received lower doses showed better serum creatinine values 3 months (1.45 vs 1.86 mg/dL, P = .013) and 12 months (1.05 vs 1.50 mg/dL, P = .04). The difference was probably due to acute tubular necrosis that produced a RR of 1.7 (P = .02; CI 1.04-2.97) when compared with patients with Scr values above 1.30 mg/dL. When censored for death, graft survival was not different between the two groups (< or =6 doses 93% vs >6 doses 97%, P = .43). CONCLUSION: Immunologic induction with Thymo produced excellent graft survival after 1 year with preservation of graft function. Delayed graft function was the most important determinant of graft function after 1 year.

Serial beta-2 microglobulin measurement as an auxilliary method in the early diagnosis of cytomegalovirus infection in renal transplant patients.

Infection by cytomegalovirus is one of the most important causes of morbidity and mortality after renal transplant. During episodes of acute rejection serum levels of beta-2 microglobulin (B2M) are elevated due to decreased excretion and/or increased production from T-cell proliferation. Sequential measurement of B2M in the first months after transplantation may detect patients at increased risk of rejection. This study assesses the usefulness of serum B2M for early detection of patients with increased risk of cytomegalovirus disease. Among 16 of 18 cases of CMV infection, there was an increase in serum B2M levels before CMV diagnosis. In all cases, B2M serum levels increased at an average of 10.8 days before the symptoms or the positive antigenemia. From a mean baseline B2M value of 5.0 mg/L, the mean value at the time of diagnosis was 7.7 mg/L before any clinical or laboratory evidence of CMV infection. These findings suggest that B2M serum levels can be used as a marker for early diagnosis of cytomegalovirus infection.