[Patient treated for severe Covid-19 with paralysis of cranial nerves]. / Kranialnervspareser uppstod hos Iva-vårdad covid-19-patient.

Patients with Covid-19 can experience neurological complications, for example cranial nerve palsy. We present a case with a patient treated for severe Covid-19 infection. She was intubated for 16 days and was ventilated in the prone-position for several hours a day during her care in the intensive care unit (ICU). She developed paralysis of the left facial nerve, observed while intubated. After extubation the patient was hoarse and had dysphagia and examination showed paralysis of the left hypoglossal nerve with the tongue deviating to the left and of the left vagus nerve causing a paralysis of the left vocal cord. It is impossible to know whether the paralysis of the three cranial nerves was due to direct damage by the Covid-19 virus or due to compression of the nerves during the ICU care. As facial nerve palsy has been shown to be more common in patients with Covid-19, we believe that the paralysis in our patient was due to a combination of both.

Regulation of fibroblast gene expression by keratinocytes in organotypic skin culture provides possible mechanisms for the antifibrotic effect of reepithelialization.

To investigate the mechanisms behind the antifibrotic effect associated with epidermal regeneration, the expression of 12 fibroblast genes important for the modulation of the extracellular matrix (ECM), as well as α-smooth muscle actin, was studied in a keratinocyte-fibroblast organotypic skin culture model. The study was performed over time during epidermal generation and in the presence or absence of the profibrotic factor transforming growth factor-ß. the Presence of epidermal differentiation markers in the model was essentially coherent with that of native skin. Fibroblast gene expression was analyzed with real-time polymerase chain reaction after removal of the epidermal layer. After 2 days of air-exposed culture, 11 out of the 13 genes studied were significantly regulated by keratinocytes in the absence or presence of transforming growth factor-ß. The regulation of connective tissue growth factor, collagen I and III, fibronectin, plasmin system regulators, matrix metalloproteinases and their inhibitors as well as α-smooth muscle actin was consistent with a suppression of ECM formation or contraction. Overall, the results support a view that keratinocytes regulate fibroblasts to act catabolically on the ECM in epithelialization processes. This provides possible mechanisms for the clinical observations that reepithelialization and epidermal wound coverage counteract excessive scar formation.

Composition of the salivary microflora during habitual consumption of fluoridated milk.

The aim was to evaluate the effect of habitual consumption of fluoridated milk on the composition of the salivary microflora. The study group comprised 20 healthy schoolchildren and young adults with a mean age of 13.6 years and the investigation had a randomized double-blind crossover design with a washout period of 1 month. After professional tooth-cleaning at baseline, the subjects were supplied with either fluoridated (250 mL, 5 ppm F) or non-fluoridated milk for one daily intake during a period of 4 weeks. Salivary samples were collected immediately before tooth-cleaning and after 1, 2, and 4 weeks, respectively. The samples were immediately cultivated for total viable counts, oral streptococci, mutans streptococci, lactobacilli, and actinomyces spp. Bacterial counts were logarithmically transformed before statistical evaluation using ANOVA. No significant alterations of the salivary microflora were found during any of the milk regimens compared with baseline. There was a slight reduction in the proportion of mutans streptococci after 2 and 4 weeks during consumption with fluoridated milk but the difference failed to reach statistical significance. In conclusion, this study was unable to disclose any significant alteration of the composition of the salivary microflora following daily intake of fluoridated milk.

Lactic acid formation in supragingival dental plaque after schoolchildren's intake of fluoridated milk.

PURPOSE: Milk can be used as vehicle for fluoride administration. The aim of this study was to investigate the lactic acid formation in dental plaque after daily intake of fluoridated milk. MATERIALS AND METHODS: The study group consisted of 15 healthy schoolchildren, 6 - 15 years of age, in a double-blind crossover study design. After a one-week fluoride depletion period, 250 ml of fluoridated (5 ppm; total amount 1.25 mg F) standard milk or non-fluoridated control milk was consumed once daily together with an ordinary meal during 3 days of plaque accumulation with no oral hygiene. On the fourth day, plaque samples were collected immediately before a final milk intake and then after 30, 60 and 180 minutes. After a washout period of two weeks, the whole procedure was repeated with the corresponding fluoridated or non-fluoridated milk regimen. All samples were suspended and the sucrose-challenged lactic acid formation rate was determined enzymatically. RESULTS: The results showed a statistically significant (p < 0.05) increase of the lactic acid levels 30 min after the intake of the standard (control) milk while no such elevation was evident after the fluoride-containing milk. No differences were found after 60 and 180 min compared with baseline for any of the milks. CONCLUSION: The findings suggest that fluoride added to milk may counteract the lactic acid formation that follows a non-fluoridated milk intake.

Fluoride concentration in supragingival dental plaque after a single intake or habitual consumption of fluoridated milk.

The aim of this study was to evaluate the fluoride concentration in supragingival dental plaque after single and repeated intakes of fluoridated milk. The study group consisted of 22 schoolchildren, young adults and adults of both sexes, 8-41 years of age. After a 2-week fluoride depletion period and 3 days of plaque accumulation, 200 ml of fluoridated milk (1g F) was ingested along with a standardized lunch meal. Plaque samples were collected immediately before the intake and after 30, 120 and 240 min. From the adult participants (n = 9) additional samples were collected after 12 and 18 h. After a fluoride-free washout period of at least 2 weeks, the whole experimental procedure was repeated after 4 consecutive daily intakes of fluoridated milk. The fluoride concentration was determined after micro-diffusion with a fluoride selective electrode. The results showed a statistically significant 3-fold increase of the plaque fluoride levels up to 4 h after the intake. At 12 and 18 h after the intake, the recorded levels went gradually back to baseline. There was no significant difference between the fluoride concentrations in the supragingival plaque after the single intake compared with the repeated intakes. In conclusion, the findings support the suggestion that milk is a suitable vehicle for local fluoride administration into the oral cavity, also when consumed together with a meal.