Association of Gut Microbiota-Related Metabolites and Type 2 Diabetes in Two Puerto Rican Cohorts.

(1) Aims: Gut microbiota metabolites may play integral roles in human metabolism and disease progression. However, evidence for associations between metabolites and cardiometabolic risk factors is sparse, especially in high-risk Hispanic populations. We aimed to evaluate the cross-sectional and longitudinal relationships between gut microbiota related metabolites and measures of glycemia, dyslipidemia, adiposity, and incident type 2 diabetes in two Hispanic observational cohorts. (2) Methods: We included data from 670 participants of the Boston Puerto Rican Health Study (BPRHS) and 999 participants of the San Juan Overweight Adult Longitudinal Study (SOALS). Questionnaires and clinical examinations were conducted over 3 years of follow-up for SOALS and 6 years of follow-up for BPRHS. Plasma metabolites, including L-carnitine, betaine, choline, and trimethylamine N-oxide (TMAO), were measured at baseline in both studies. We used multivariable linear models to evaluate the associations between metabolites and cardiometabolic risk factors and multivariable logistic and Poisson regressions to assess associations with prevalent and incident type 2 diabetes, adjusted for potential confounding factors. Cohort-specific analyses were combined using a fixed-effects meta-analysis. (3) Results: Higher plasma betaine was prospectively associated with lower fasting glucose [-0.97 mg/dL (95% CI: -1.59, -0.34), p = 0.002], lower HbA1c [-0.02% (95% CI: -0.04, -0.01), p = 0.01], lower HOMA-IR [-0.14 (95% CI: -0.23, -0.05), p = 0.003], and lower fasting insulin [-0.27 mcU/mL (95% CI: -0.51, -0.03), p = 0.02]. Betaine was also associated with a 22% lower incidence of type 2 diabetes (IRR: 0.78, 95% CI: 0.65, 0.95). L-carnitine was associated with lower fasting glucose [-0.68 mg/dL (95% CI: -1.29, -0.07), p = 0.03] and lower HbA1c at follow-up [-0.03% (95% CI: -0.05, -0.01), p < 0.001], while TMAO was associated with higher fasting glucose [0.83 mg/dL (95% CI: 0.22, 1.44), p = 0.01] and higher triglycerides [3.52 mg/dL (95% CI: 1.83, 5.20), p < 0.0001]. Neither choline nor TMAO were associated with incident type 2 diabetes. (4) Conclusions: Higher plasma betaine showed consistent associations with a lower risk of glycemia, insulinemia, and type 2 diabetes. However, TMAO, a metabolite of betaine, was associated with higher glucose and lipid concentrations. These observations demonstrate the importance of gut microbiota metabolites for human cardiometabolic health.

Periodontal Health Knowledge and Oral Health-Related Quality of Life in Caribbean Adults.

PURPOSE: To identify the relationship between periodontal health knowledge and oral health-related quality of life among Caribbean adults. MATERIALS AND METHODS: A cross-sectional study was conducted in a representative sample from 3 Caribbean cities (weighted N = 1805). Participants completed a questionnaire on oral health knowledge, hygiene habits, and other practices, as well as the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The associations between knowledge and habits and OHIP-14 score and its tertiles were evaluated using negative binomial and multinomial logistic regression models, respectively, adjusting for confounders. Odds ratios and regression coefficients were reported. RESULTS: Participants reporting none, little, and adequate knowledge about gum health had higher odds of being in the worst tertile for OHRQoL, compared to those reporting "good knowledge" (ORnone vs good = 2.38, 95% CI: 1.59-3.54; ORlittle vs good = 1.82, 95% CI: 1.19-2.78; ORadequate vs good = 1.68, 95% CI: 1.11-2.57). Participants reporting toothbrushing ≥ twice/day were less likely to be in the worst tertile for OHRQoL, compared to those brushing less often (OR = 0.67, 95% CI: 0.48-0.92). Self-reported gum bleeding was associated with double the odds of being in the worse tertile (OR = 2.03, 95% CI: 1.60-2.58). CONCLUSION: According to the findings of this study, periodontal health knowledge is associated with reduced OHRQoL in Caribbean Adults. In addition, the frequency of brushing and the self-reported gum bleeding was related to a worse quality of life (QoL) level.

Determining the safety of the tobacco cembranoid (1S,2E,4R,6R,7E,11E)-Cembratriene-4,6-diol (4R): A translational study in nonhuman primates.

The tobacco cembranoid known as (1S,2E,4R,6R,7E,11E)-2,7,11-cembratriene-4,6-diol (4R) has been shown to offer neuroprotection against conditions such as brain ischemia, systemic inflammation, Parkinson's disease, and organophosphate toxicity in rodents. Previous safety studies conducted on male and female Sprague Dawley rats revealed no significant side effects following a single injection of 4R at varying concentrations (6, 24, or 98 mg/kg of body weight). This study aimed to assess the potential of 4R for clinical trials in neurotherapy in male nonhuman primates. Ten macaques (Macacca mulatta) were randomly separated into two groups of 5 and then intravenously injected with 4R or vehicle for 11 consecutive days at a dose of 1.4 mg/kg. Throughout the study, we monitored brain activity by electroencephalogram, somatosensory evoked potentials, and transcranial motor evoked potentials on days 0, 4, 8, and 12 and found no significant changes. The spontaneous behavior of the primates remained unaffected by the treatment. Minor hematological and blood composition variations were also detected in the experimental animals but lacked clinical significance. In conclusion, our results reinforce the notion that 4R is non-toxic in nonhuman primates under the conditions of this study.

3D Accuracy of a Conventional Method Versus Three Digital Scanning Strategies for Completely Edentulous Maxillary Implant Impressions.

PURPOSE: To compare the 3D accuracy of three scanning strategies and conventional impressions using an edentulous model with six implants. MATERIALS AND METHODS: An edentulous maxillary master model was fabricated with six equigingival internal connection implants at 0 degrees of angulation. Ten conventional open-tray splinted implant-level impressions were made and poured in stone. A master model and conventional casts were digitized with a reference scanner. Digital impressions were made by calibrated clinicians with a TRIOS 3 intraoral scanner ([IOS] 3Shape) according to three scanning strategies: DIG1 (occlusal-palatal-lingual), DIG2 (S-type motion from buccal to palatal), and DIG3 (scanning two half arches and connecting them at the midline). Each technique was repeated 10 times on the master model. Deviations from the STL datasets (N = 40) were compared to those of the reference master model using the Hexagon Metrology software system PC-DMIS CAD++. Linear distortions (dX, dY, dZ), global linear distortion (dR), and angular distortions (Absdθx, Absdθy) were calculated. Kruskal-Wallis test and mixed linear and logistic regression models were used to compare the original and binary distortion measures between the techniques. RESULTS: The mean dR ranged from 91 µm (conventional method) to 183 µm (DIG1). The mean angular distortion ranged from 0.20 degrees (Absdθx for DIG2) to 0.69 degrees (Absdθy for DIG3). No scan pattern resulted in a more accurate reproduction in any of the measured parameters than the conventional impression method. There were significant differences between the methods for all distortion measures. CONCLUSIONS: No group reproduced the 3D position of the six-implant master model below the thresholds for both global linear and angular distortions. All the digital strategies tested were less accurate than the conventional open-tray splinted implant-level impression technique.

Comparison of Corticotomy and Micro-osteoperforation during Canine Retraction: A Split-Mouth Design.

OBJECTIVE: Compare the efficacy of the micro-osteoperforation (MOP) and corticotomy techniques in terms of maxillary canine retraction. METHODS: Thirteen patients (5 females, 8 males; mean age, 18.07 ± 6.74 years) with healthy permanent dentition and requiring the extraction of maxillary first premolars were included in a split-mouth randomized clinical trial. Those subjects with previous orthodontic or endodontic treatment of the canines were excluded. At least 3 months post-extraction, MOPs and corticotomies were performed distal to the canines. Mini-screws with closed-coil springs (150 g) were used for the canine retraction. Dental casts were made at baseline (T0) and 3 months post-intervention (T1). Trained and calibrated examiners measured the distances from the canines to the second premolars on both sides. A signed-rank sum test was used to compare the amount of canine retraction achieved in 3 months (T0-T1) on the 2 sides. RESULTS: Retraction (mm) at the incisal level was similar in the corticotomy (3.34 ± 1.01) and MOP patients (2.74 ± 1.10) (P = 0.11); furthermore, there were no differences in the degree of medial retraction between the corticotomy (2.56 ± 0.67) and MOP (2.27 ± 0.82) (P = 0.31) procedures. No adverse events were observed. CONCLUSION: There were not any clinically or statistically significant differences in retraction between the interventions. At 3 months, a MOP is as effective as a corticotomy in accelerating the rate of tooth movement.

Pre- and peri-natal hurricane exposure alters DNA methylation patterns in children.

Hurricane Maria was the worst recorded natural disaster to affect Puerto Rico. Increased stress in pregnant women during and in the aftermath of the hurricane may have induced epigenetic changes in their infants, which could affect gene expression. Stage of gestation at the time of the event was associated with significant differences in DNA methylation in the infants, especially those who were at around 20-25 weeks of gestation when the hurricane struck. Significant differences in DNA methylation were also associated with maternal mental status assessed after the hurricane, and with property damage. Hurricane Maria could have long lasting consequences to children who were exposed to this disaster during pregnancy.

Downregulation of miRNA-26 in chronic periodontitis interferes with innate immune responses and cell migration by targeting phospholipase C beta 1.

AIM: To evaluate the potential role of miR-26 family members in periodontal pathogenesis by assessing innate immune responses to periopathic bacteria and regulation of cytoskeletal organization. MATERIALS AND METHODS: Expression of miR-26a-5p and miR-26b-5p was quantified in gingival biopsies derived from healthy and periodontally diseased subjects before and after non-surgical (scaling and root planing) therapy by RT-qPCR. Global pathway analysis and luciferase assays were performed for target identification and validation. Cytokine expression was assessed in miR-26a-5p transfected human oral keratinocytes upon stimulation with either live Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans or Pg lipopolysaccharide (LPS). Wound closure assays were performed in cells transfected with miR-26a-5p, while the impact on cytoskeletal organization was assessed by F-actin staining. RESULTS: miR-26a-5p and miR-26b-5p were downregulated in diseased gingiva and restored 4-6 weeks post-therapy to levels comparable with healthy subjects. Target validation assays identified phospholipase C beta 1 as a bona fide novel target exhibiting antagonistic expression pattern in disease and post-therapy cohorts. miR-26a-5p transfected cells secreted higher levels of cytokine/chemokines upon stimulation with periopathogens and demonstrated impaired cell migration and cytoskeletal rearrangement. CONCLUSIONS: Downregulated miR-26a-5p levels in periodontal inflammation may interfere with key cellular functions that may have significant implications for host defence and wound healing.

Socio-Demographic and Medical Characteristics of Patients With Odontogenic Infection Admitted to the Adult University Hospital in Puerto Rico: A Cross-sectional Study.

OBJECTIVE: We aimed to estimate the overall distribution of odontogenic infection by socio-demographic and medical characteristics in patients admitted to the Adult University Hospital (AUH) in Puerto Rico (PR). METHODS: A cross-sectional study was undertaken with the medical charts of 129 patients (≥21 years) with odontogenic infection who had been admitted (2011-2015) to the AUH and treated by the Oral and Maxillofacial Surgery Post - graduate Program of the University of PR. The patients were selected from the hospital's billing database after having been identified using the International Classification of Diseases (9th and 10th revisions). The study variables included age, gender, municipality of residence, medical insurance, infection etiology, surgical and antibiotic treatments, length of stay (LOS), and the presence of diabetes. Descriptive and frequency statistics were calculated for all the variables; chi-squared, Kruskal-Wallis, Kendall tau, and Mann-Whitney tests were performed. A P < .05 was considered statistically significant. RESULTS: The mean age of the subjects was 40.36 (SD: 14.74) years, and they ranged in age from 21 to 81 years; the majority were enrolled in the public health insurance plan of PR. The leading cause of infection was dental caries. Diabetes was associated with longer LOSs; P < .01. CONCLUSION: In our study, the relative frequency of admitted patients with an odontogenic infection, most of them with low income, increased over time with dental caries being the principal cause of infection.

Novel Plasma Metabolomic Markers Associated with Diabetes Progression in Older Puerto Ricans.

We assessed longitudinal associations between plasma metabolites, their network-derived clusters, and type 2 diabetes (T2D) progression in Puerto Rican adults, a high-risk Hispanic subgroup with established health disparities. We used data from 1221 participants free of T2D and aged 40-75 years at baseline in the Boston Puerto Rican Health and San Juan Overweight Adult Longitudinal Studies. We used multivariable Poisson regression models to examine associations between baseline concentrations of metabolites and incident T2D and prediabetes. Cohort-specific estimates were combined using inverse-variance weighted fixed-effects meta-analyses. A cluster of 13 metabolites of branched chain amino acids (BCAA), and aromatic amino acid metabolism (pooled IRR = 1.87, 95% CI: 1.28; 2.73), and a cell membrane component metabolite cluster (pooled IRR = 1.54, 95% CI: 1.04; 2.27) were associated with a higher risk of incident T2D. When the metabolites were tested individually, in combined analysis, 5 metabolites involved in BCAA metabolism were associated with incident T2D. These findings highlight potential prognostic biomarkers to identify Puerto Rican adults who may be at high risk for diabetes. Future studies should examine whether diet and lifestyle can modify the associations between these metabolites and progression to T2D.

Prevalence of Short Root Anomaly in a Group of Puerto Ricans.

OBJECTIVE: To estimate the prevalence of short root anomaly (SRA) in a group of Puerto Ricans at the Advanced Education Program in Orthodontics of the University of Puerto Rico. METHODS: A cross-sectional study was conducted with digital panoramic x-rays of 203 patients (112 females and 91 males; mean age: 17 years) in Puerto Rico. Utilizing the modified Lind's method, 406 maxillary right and left central incisors (1) were measured and evaluated for SRA. Root and crown length and R/C ratio were compared by sex and side. Linear regression was used to evaluate the associations between the R/C ratio and age, sex, and side (right/left). All the statistical analyses were evaluated using significance level of .05 (2). RESULTS: The prevalence of SRA was 0.49%. The average root and crown lengths for the maxillary right and left central incisors were 19.47 and 10.28 mm, respectively. Sex was associated with root and crown length, not with the R/C ratio. No differences were observed in the R/C ratio by the side. There were no significant associations between age, sex, and side and R/C ratio in the multivariate analysis. CONCLUSION: The prevalence of SRA in our population is lower than any reported in the literature. The R/C ratio in our Hispanic population was the highest compared with those of other ethnicities. Neither the sex nor the side of the incisor was associated with the R/C ratio. These findings are contrary to those of prior reports stating that males have higher R/C ratios than females.

Implementing a pharmacogenetic-driven algorithm to guide dual antiplatelet therapy (DAPT) in Caribbean Hispanics: protocol for a non-randomised clinical trial.

INTRODUCTION: Minority populations in the USA are disproportionately affected by cardiovascular conditions. Reduced responsiveness to clopidogrel among carriers of CYP2C19 variants has been reported in patients with either coronary artery disease (CAD) or acute coronary syndrome (ACS) after the percutaneous coronary intervention (PCI). Previous studies have evaluated CYP2C19 genotyping-guided antiplatelet therapy in selected populations; however, this has yet to be tested among Hispanics. Given the paucity of clinical research on CYP2C19 and antiplatelet clinical outcomes in Hispanics, our study will test the safety and efficacy of a genetic-driven treatment algorithm to guide dual antiplatelet therapy (DAPT) in Caribbean Hispanics. METHODS AND ANALYSIS: This is a multicentre, prospective, non-randomised clinical trial that proposes an assessment of pharmacogenomic-guided DAPT in post-PCI Caribbean Hispanic patients with ACS or CAD. We will recruit 250 patients to be compared with a matched non-concurrent cohort of 250 clopidogrel-treated patients (standard-of-care). Major adverse cardiovascular events (MACEs) such as all-cause death, myocardial infarction (MI), stroke, coronary revascularisation, stent thrombosis and bleedings over 6 months will be the study endpoints. Among the recruited, high-risk patients will be escalated to ticagrelor and low-risk patients will remain on clopidogrel. The primary objective is to determine whether genetic-guided therapy is superior to standard of care. The secondary objective will determine if clopidogrel treatment in low-risk patients is not associated with a higher rate of MACEs compared with escalated antiplatelet therapy in high-risk patients. Patients will be enrolled up to the group's completion. ETHICS AND DISSEMINATION: Approval was obtained from the Institutional Review Board of the University of Puerto Rico Medical Sciences Campus (protocol # A4070417). The study will be carried out in compliance with the Declaration of Helsinki and International Conference on Harmonization Good Clinical Practice Guidelines. Findings will be published in a peer-reviewed journal and controlled access to experimental data will be available. TRIAL REGISTRATION NUMBER: NCT03419325; Pre-results.

Prevalence of Dental Caries in 12-Year-Olds in San Pedro de Macorís, DR.

OBJECTIVE: Dental caries is one of the most prevalent chronic diseases in children. Currently, no data are available on dental caries prevalence in the Dominican Republic. The purpose of this study was to estimate the prevalence of dental caries in schoolattending 12-year-olds in San Pedro de Macorís, Dominican Republic. METHODS: A cross-sectional epidemiological study using a probabilistic sample, stratified by type of school (public/private) and gender, was conducted. Two calibrated examiners conducted the evaluations of oral soft/hard tissues. Caries experience was summarized in terms of prevalence; the number of decayed, missing, and filled teeth (DMFT) and surfaces (DMFS); and the significant caries (SiC) index, in all the participants, and by gender and school type. Logistic and Poisson regression models were used to compare caries experience by sex and school type. RESULTS: Four hundred and two 12-year-olds enrolled in 14 public and 11 private schools were evaluated. The overall dental caries prevalence was 73%. The mean DMFS was 3.87, the mean DMFT was 2.64, and the SiC index was 5.07. Girls had significantly higher mean DMFS, DMFT, and SiC indices than did boys. Public school attendees had significantly higher DMFS, DMFT, and SiC indices than did those children attending private schools. The decayed (D) component accounted for 71% of the DMFT value. CONCLUSION: The WHO's goal of all 12-year-olds having a DMFT less than or equal to 3 was met by all the participants in our study. Girls and public-school attendees carry the burden of the disease. The high D component of the index suggests that there are unmet dental-caries needs. This information will assist in the design and implementation of future primary and secondary prevention programs.

Prevalence, Severity, and Risk Factors of Gingival Inflammation in Caribbean Adults: A Multi-City, Cross-Sectional Study.

OBJECTIVE: To estimate the prevalence, severity, and associated risk factors of gingival inflammation in a group of adults from Kingston, Jamaica; Santo Domingo, Dominican Republic; and San Juan, Puerto Rico. METHODS: In this representative cross-sectional study, participants completed medical and oral health questionnaires and received an oral clinical examination by trained and calibrated examiners. Clinical assessments included: gingival health (modified Löe-Silness index), visible plaque and presence of calculus. Findings were summarized as mean overall and interproximal gingival indices (GI; IGI), gingival bleeding index (GBI), gingival inflammation prevalence (GI>=0.5) and severity (mild, moderate, severe), mean and interproximal visible plaque indices (VPI; IVPI), and calculus index. Multivariate logistic regression was used to evaluate the associations between risk factors and gingival bleeding on probing (BOP) at >= 40% sites;. odds ratios were estimated. RESULTS: All 1,847 participants presented gingival inflammation; most (81.9%) had moderate inflammation. Mean GI, VPI, IVPI, and calculus indices were 1.49, 0.94, 0.96, and 0.66, respectively; most participants presented a VPI >= 30%. BOP >= 40% of sites was significantly associated with education (ORmiddle/technical vs. university education=1.61; p =0.001 and ORnone/basic vs. university= 2.86; p<0.001), calculus index (OR: 10.35), VPI >= 30% (OR: 7.85; p<0.001 for both), and being a resident of Kingston or Santo Domingo (vs. San Juan, OR: 4. 74 and OR: 7.09, respectively), after adjusting for age, gender, smoking, dental visit frequency, diabetes, and hypertension. CONCLUSION: Gingival inflammation was highly prevalent. Most participants presented moderate gingival inflammation. Educational attainment, dental calculus, and VPI >= 30% were strongly associated with gingival inflammation.

Prevalence of gingivitis and calculus in 12-year-old Puerto Ricans: a cross-sectional study.

BACKGROUND: Gingivitis is a common oral health problem. Untreated gingivitis may progress to periodontitis, a common cause of tooth loss. The prevalence of gingivitis and calculus among Puerto Rican children is unknown. Understanding this prevalence can support early public health preventative strategies. This study aims to estimate the prevalence of gingivitis and calculus among 12-year-old Puerto Ricans by health region and to explore differences in distribution by school type (proxy for socio-economic status) and gender. METHODS: A probability-based sample of 113 schools was selected proportional to enrollment size and stratified by health region, school type, and gender. Two trained examiners evaluated the presence of gingivitis and both supragingival and subgingival dental calculus. Gingivitis was defined as the presence of gingival bleeding upon gentle probing (BOP) in at least one site, and the extent of the problem was classified according to the percentage of teeth whose gingiva presented BOP (limited: 25-49% of the teeth tested; extensive: >50% of teeth tested). Logistic and linear regression models, adjusted for health regions, were used to compare gingivitis and calculus prevalence and extent between genders and school types. RESULTS: Gingivitis was found in 80.41% of the 1586 children evaluated. Urban-public schoolchildren had a slightly higher prevalence (83.24%) compared to private (79.15%, p = 0.16); those in rural-public (77.59%) and private schools had similar prevalence (p = 0.15). Extensive gingivitis was present in 60.81% of all children. The mean percentage of sites presenting BOP (BOP%) was 17.79%. Rural and urban public schoolchildren presented significantly higher BOP% compared to children from private schools (p = 0.0005, p = 0.002, respectively). Dental calculus was detected in 61.59% of the sample, boys presenting significantly higher (p = 0.005) total and supragingival calculus. Rural-public schoolchildren had a significantly higher prevalence of subgingival calculus compared to private schoolchildren (p = 0.02). CONCLUSIONS: Gingivitis prevalence is higher among 12-year-old Puerto Ricans compared to data reported for U.S. adolescents. Public schoolchildren presented significantly higher BOP% sites compared to private schoolchildren. Boys presented a significantly higher total and supragingival calculus prevalence than girls. Oral health disparities related to gender and school type were identified by this study. Studies exploring the reasons for these disparities are recommended.

Prevalence of Gingivitis in a Group of 35- to 70-Year-Olds Residing in Puerto Rico.

OBJECTIVE: Gingivitis, an inflammation of the gingival tissues, typically progresses to periodontitis. The objective of this study is to estimate the prevalence of gingivitis in 35- to 70-year-olds residing in San Juan, Puerto Rico, and assess the differences in gingivitis distribution between age and gender groups. METHODS: A cross-sectional epidemiological study was conducted with a sample of patients from a private practice and patients/employees of the Puerto Rico Medical Center. Participants completed a medical history questionnaire and received soft/hard tissue and gingival assessments based on a modified Löe-Silness index. Descriptive statistics were employed to estimate the overall gingivitis prevalence, severity (mild, moderate, severe), and mean gingival index (GI). Bleeding on probing (BOP) prevalence and the mean percentage of BOP sites were calculated by gender and age. Multinomial logistic regression was used to evaluate the associations between age, gender, and severity in 3 categories; multivariate logistic regression was used for having >=40% sites with BOP (vs. having <40% sites with BOP as reference). Odds ratios were also estimated. RESULTS: All 300 participants (52% women; 48% men) had gingivitis. The mean GI was 1.38. Moderate gingivitis was detected in 83% of the participants, mild in 7.3%, and severe in 9.3%. BOP was observed in 99% of the subjects (mean % BOP sites = 34%). After adjusting for age, men had significantly higher odds of moderate (OR = 4.66) and severe gingivitis (OR =10.06), compared to women, as well as 1.76 times higher odds of having 40% or more sites with BOP. CONCLUSION: Gingivitis was observed in all participants. Men had significantly higher GI, compared to women. The prevalence of gingivitis was higher in Puerto Rico than in the US.

Prevalence of Malocclusion and Distribution of Occlusal Characteristics in 13- to 18-year-old Adolescents Attending Selected High Schools in the Municipality of San Juan, PR (2012-2013).

OBJECTIVE: A cross-sectional study was conducted (2012-2013) to evaluate the prevalence of 1) malocclusion and 2) occlusal characteristics in 13- to 18-yearold adolescents in San Juan, Puerto Rico (PR) from selected high schools in the municipality of San Juan. METHODS: The study sample consisted of 155 adolescents. The University of Puerto Rico's IRB approved the study and consent and assent were completed for or by each participant, as applicable. A calibrated dentist performed a single-visit dental evaluation at each school. Occlusal characteristics were measured and recorded according to the criteria reported in the US National Health and Nutrition Examination Survey (NHANES III) and included overjet, overbite, anterior and posterior crossbites, incisor irregularity, maxillary midline diastema and Angle's classification. Descriptive and inferential statistical analyses were performed using SAS statistical software. RESULTS: The mean age of the study subjects was 16 (±1.2) years; all subjects (100%) presented at least 1 abnormal occlusal trait. The most frequent anomaly noted was maxillary malalignment (83%), followed by lower incisor irregularity and excessive overbite (79%) and excessive overjet (63%); the least common occlusal trait was open bite (1.9%). Compared by gender, no statistically significant difference was observed for any variable (p = 0.05). Seventy-three percent (73%) of the subjects presented with Class I malocclusion, 7.1% with Class II malocclusion and 19.4% with Class III malocclusion. CONCLUSION: A high prevalence of malocclusion was observed in this group of adolescents, highlighting the need to implement preventive measures to improve oral health in this population.

Fine-Needle Thyroid Aspiration Biopsy: Clinical Experience at the Endocrinology Clinics of the University Hospital of Puerto Rico.

OBJECTIVE: This study aimed to establish a profile of the ultrasound-guided thyroid fine-needle aspiration biopsies (FNABs) performed at the endocrinology clinics of the University Hospital of Puerto Rico. METHODS: A retrospective study was conducted to assess all the thyroid FNABs performed from July 1, 2011, to December 31, 2013. Data on socio-demographic, FNAB cytology, surgery, and histopathology were collected from medical records. A chi-square test was used to assess associations between predictors and outcome. McNemar's test was used to compare FNAB cytology and histopathology results. RESULTS: A total of 240 FNABs were performed on 192 patients; 91.2% were female. The distribution of the cytological diagnoses was as follows: 181 (75.4%) were benign; 39 (16.3%) were non-diagnostic; 15 (6.3%) were indeterminate; and 5 (2.1%) were malignant. A malignant cytology was more likely in patients younger than 45 y/o than in their older counterparts (p = 0.01); a similar result was found for patients who smoked vs. those who did not (p = 0.02). Benign nodules were more likely to be larger than 1 cm than were those that were malignant (88.2% vs. 25%). Histopathology results were available for 38 nodules; there were no statistically significant differences between the cytology and histopathology results (p>0.05). The sensitivity and specificity for FNAB cytology were 75% and 100%, respectively. Of the nodules with an initial indeterminate cytology (47%), 71% demonstrated, ultimately, benign histopathology. CONCLUSION: In our study, most of the FNABs performed yielded a benign cytology. A high concordance was shown between cytology and histology. For those with indeterminate cytology, the majority of cases demonstrated benign histopathology. These data suggest the need to implement other approaches, such as the development and subsequent use of molecular markers, to improve our diagnostic and therapeutic strategies, this according to our population-based disease prevalence.

A Semi-Quantitative Food Frequency Questionnaire Validated in Hispanic Infants and Toddlers Aged 0 to 24 Months.

BACKGROUND: There are limited validated food frequency questionnaires (FFQs) for infants and toddlers, most of which were evaluated in Europe or Oceania, and the ones available for use in the United States have important limitations. OBJECTIVE: Our aim was to assess the validity of an FFQ developed for infants and toddlers. DESIGN: A semi-quantitative FFQ was developed that included 52 food items, their sources, and portion sizes. The FFQ inquired about diets over the previous 7 days. Its validity was assessed in a cross-sectional study. Participants completed the FFQ, followed by a 24-hour recall on two occasions with 1 week between data collection. PARTICIPANTS/SETTING: A total of 296 caregivers of infants and toddlers aged 0 to 24 months enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children, Puerto Rico. MAIN OUTCOME MEASURES: Intake of nutrients and food groups were averaged for the two FFQs and the two 24-hour food recalls, and adjusted for energy intake. STATISTICAL ANALYSES PERFORMED: Spearman correlations were performed for intakes of energy, nutrients, and foods between administrations and between instruments. Correlation coefficients were de-attenuated to account for variation in the 24-hour recalls. RESULTS: A total of 241 participants completed the study. Intake of all nutrients and foods were significantly correlated between FFQs and 24-hour recalls and between the means of FFQs and 24-hour food recalls. The de-attenuated correlation for nutrients between the FFQs and 24-hour recalls ranged from 0.26 (folate) to 0.77 (energy), with a mean correlation of 0.53. The de-attenuated correlation for food groups between the FFQs and 24-hour recalls ranged from 0.28 (sweets) to 0.80 (breast milk), with a mean correlation of 0.55. When analyses were restricted to those consuming foods other than breast milk or formula (n=186), results were similar. CONCLUSIONS: This semi-quantitative FFQ is a tool that offers reasonably valid rankings for intake of energy, nutrients, foods, and food groups in this sample of infants and toddlers.

Association between Type, Amount, and Pattern of Carbohydrate Consumption with Dental Caries in 12-Year-Olds in Puerto Rico.

OBJECTIVE: To identify the types, food sources, and pattern of carbohydrates that significantly contribute to dental caries in Puerto Rican children. METHODS: As part of an island-wide cross-sectional oral health study in 1,587 twelve-year-olds, diet intake was assessed in a representative subset (n = 801) with a 24-hour dietary recall. Carbohydrate intake was quantified using a computer-based diet analysis program. Caries was assessed using the National Institute of Dental and Craniofacial Research diagnostic criteria. Odds ratios were used to associate carbohydrate intake quartiles with caries, after controlling for important confounders. RESULTS: A total of 723 subjects had complete data. Most were females (54%) and attended public schools (77%). The caries prevalence was 33%. The highest quartile intake for the following sugars significantly increased the odds of caries compared to the lowest quartile: total carbohydrates (OR = 1.93, 95% CI = 1.08-3.46), total sugars (OR = 1.88, 95% CI = 1.01-351), sucrose (OR = 2.05, 95% CI = 1.13-3.70), fructose (OR = 1.95, 95% CI = 1.05-3.62), and inositol (OR = 2.52, 95% CI = 1.38-4.63). The main food sources of these sugars were juices, including natural juices with no added sugars, and sweetened beverages. The odds of caries also increased significantly in children whose 10% of total energy intake was from total sugars (OR = 3.76, 95% CI = 1.03-13.7). CONCLUSION: After adjusting for important caries risk factors, total carbohydrates, total sugars, ≥10% kilocaloric energy from total sugars, and sucrose, fructose, and inositol intake significantly increased caries risk. Our findings can help raise awareness about the potential caries risk from the main sources of these sugars, natural fruit juices and sweetened beverages, which are consumed in great quantities in many societies.