Wound, Ischemia, Foot Infection (Wifi) Classification System And Its Predictive Ability Concerning Amputation-Free Survival, Mortality And Major Limb Amputation In A Portuguese Population: A Single Center Experience.

INTRODUCTION: Commonly used chronic limb-threatening ischemia (CLTI) classifications lack granularity and detail to precisely stratify patients according to risk of limb loss, expected revascularization benefit and mortality. The aim of this study is to evaluate in a Portuguese population the prognostic value of an updated CLTI classification based on Wound, Ischemia, and foot Infection (WIfI) proposed by the Society for Vascular Surgery. MATERIALS AND METHODS: Single-center retrospective evaluation of prospectively collected data of consecutive patients with CLTI submitted to lower limb revascularization from January to December of 2017. All consecutive patients with chronic peripheral artery disease with ischemic rest pain or tissue loss were included. The exclusion criteria were patients with intermittent claudication, vascular trauma, acute ischemia, non-atherosclerotic arterial disease and isolated iliac intervention. The primary end-point was major limb amputation, mortality and amputation-free survival (AFS) at 30 days, 1 year and 2 year follow-up. Secondary end-points were minor amputation, wound healing time (WHT) and rate (WHR). RESULTS: A total of 111 patients with CLTI were submitted to infra-inguinal revascularization: 91 endovascular and 20 open surgery. After categorizing them according to the WIfI: 20 had stage 1 (18.52%), 29 stage 2 (26.85%), 38 stage 3 (35.19%) and 21 stage 4 (19.44%). Overall mortality rate was 1.8%, 17% and 22.3% at 30 days, 1 year and 2 years follow-up. Major amputation rate was 0.9%, 2.7% and 2.7% at 30 days, 1 year and 2 years follow-up. AFS rate was 97.3%, 82.1%, and 76.8% at 30 days, 1 year, 2 years follow-up. In multi-variable analysis, higher WIfI score was the only predictive factor for mortality and AFS. WIfI 3 and 4 were also associated with increased risk of non-healing ulcer. CONCLUSION: This study proved the prognostic value of the WIfI classification in a Portuguese population by showing an association between higher scores and increased mortality, lower AFS and non-healing ulcer.

Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review.

OBJECTIVES: To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. METHODS: Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. RESULTS: 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). CONCLUSIONS: CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.

Epidemiology of Nontyphoidal Salmonella Bloodstream Infections in Children.

BACKGROUND: Nontyphoidal Salmonella (NTS) infections are the most common culture-confirmed foodborne illness in the United States. Although extremes of age and chronic or immunosuppressing conditions are known risk factors for NTS bloodstream infection (BSI), further predictors of BSI and BSI with focal infection in children remain poorly understood. METHODS: This was a retrospective review of NTS-positive blood cultures collected from 1999 to 2018 and stool studies collected from 2009 to 2018 in children. Incidence rates and risk factors for NTS BSI with and without focal infection were determined. RESULTS: Incidence rates of NTS BSI have not decreased over the last 20 years. There were 211 cases of NTS BSI with an incidence rate of 1.4 per 100 000 children per year. Twenty-one (10%) had underlying comorbidities. S. heidelberg was the most common serotype occurring in 45 (21%) cases. Compared with children with uncomplicated NTS BSI, children with NTS BSI with focal infection were more likely to have an underlying comorbidity, less diarrhea, and higher absolute neutrophil count. On multivariable analysis, the only difference in having NTS BSI in children with NTS gastroenteritis who had blood cultures obtained was a longer duration of fever (4.4 vs 2.5 days), less bloody diarrhea, and S. heidelberg isolated from stool. Laboratory studies, group of NTS, and other symptoms were not significant. CONCLUSIONS: Clinicians should remain vigilant for NTS BSI in children with prolonged fevers. S. heidelberg is the most common cause of NTS BSI in children and a predictor of BSI in children with NTS gastroenteritis.

Prevalence of Different Courses of Feline Leukaemia Virus Infection in Four European Countries.

Prevalence of progressive feline leukaemia virus (FeLV) infection is known to still be high in cats in Europe, especially in Southern Europe, but the prevalence of other outcomes of FeLV infection has not been determined in most countries. The present study aimed to investigate the prevalence of progressive, regressive, abortive, and focal infection in four European countries, two with a high (Italy, Portugal) and two with a low expected prevalence (Germany, France). Blood samples of 934 cats (Italy: 269; Portugal: 240; France: 107; Germany: 318) were evaluated for the p27 antigen, as well as anti-whole virus, anti-SU, and anti-p15E antibodies by enzyme-linked immunosorbent assay (ELISA) in serum and for proviral DNA by quantitative polymerase chain reaction (qPCR) in whole blood. Positive p27 antigen ELISA results were confirmed by reverse transcriptase-qPCR (RT-qPCR) detecting viral RNA in saliva swabs and/or blood. The outcome of FeLV infection was categorised as progressive (antigen-positive, provirus-positive), regressive (antigen-negative, provirus-positive), abortive (antigen- and provirus-negative, antibody-positive), and focal (antigen-positive, provirus-negative) infection. Overall FeLV prevalence was 21.2% in Italy, 20.4% in Portugal, 9.5% in Germany, and 9.3% in France. Prevalence of progressive, regressive, abortive, and focal infection in Italy was 7.8%, 4.5%, 6.3%, and 2.6%; in Portugal 3.8%, 8.3%, 6.7%, and 1.7%; in Germany 1.9%, 1.3%, 3.5%, and 2.8%; in France 1.9%, 3.7%, 2.8%, and 0.9%, respectively. In conclusion, overall FeLV prevalence is still very high, especially in Southern European countries. Therefore, testing, separation of infected cats, and vaccination are still important measures to reduce the risk of FeLV infection.

Predictors of infectious foci on FDG PET/CT in Staphylococcus aureus bacteremia.

We looked for predicting factors for the detection of infectious foci on 18F-fluorodeoxyglucose-positron emission tomography in combination with computed tomography (FDG PET/CT) among patients with Staphylococcus aureus bacteremia (SAB) who participated in an interventional study that was conducted at Rambam Health Care Campus, between July 1, 2015 and February 1, 2019. The primary outcome was an infectious focus detected by FDG PET/CT. Independent predictors for detection of focal infection were identified using univariate followed by a logistic regression multivariate analysis. We included 149 patients with 151 separate episodes of SAB who underwent FDG-PET/CT. Focal infections were detected in 107 patients (70.8%). Independent predictors for focal infection detection were community acquisition of bacteremia with odds ratio (OR) 3.03 [95% confidence interval (CI) 1.04-8.77], p-0.042 and C reactive protein (CRP) with OR 1.09 [95% CI 1.04-1.14], p < 0.001. Primary bacteremia was inversely associated with focal infection detection with OR 0.27 [0.10-0.69], p = 0.007, as were the pre-scan blood glucose levels OR 0.9 [0.98-0.99], p-0.004. The latter stayed significant in the subgroup of patients with diabetes mellitus. To conclude, patients with community-acquired bacteremia or high CRP levels should be carefully investigated for focal infection. Patients who present with primary bacteremia seem to be at low risk for focal infection.

Asociación entre índice de masa corporal y mortalidad en pacientes críticos con choque séptico / Association between body mass index and mortality in critical ill patients with septic shock

INTRODUCCIÓN. La paradoja de la obesidad propone que, en determinadas enfermedades, los enfermos con obesidad tienen menor mortalidad. OBJETIVO. Asociar el índice de masa corporal con la mortalidad a 30 días en adultos con choque séptico. MATERIALES Y MÉTODOS. Estudio observacional, analítico, retrospectivo, multicéntrico. Se analizaron 673 pacientes con choque séptico, ingresados en terapia intensiva de dos hospitales de la ciudad de la ciudad de Quito ­ Ecuador, durante enero 2017 - diciembre 2019. Criterios de inclusión: Mayores a 18 años, choque séptico, registro de peso, talla y condición vital al día 30. Criterios de exclusión: Orden de no reanimación, embarazadas, protocolo de donación de órganos, cuidados paliativos. Las variables se recolectaron a partir de las historias clínicas digitales y físicas de los centros participantes. Las estimaciones de riesgo calculadas se presentaron como OR (Odds Ratio) en el análisis bivariado y OR Adj (OR ajustado) para el análisis multivariado. Un valor de p <0.05 se consideró estadísticamente significativo. Todos los análisis estadísticos se realizaron usando el software estadístico R® (Versión 4.1.2). RESULTADOS. La edad promedio fue de 65 años, índice de masa corporal promedio 25,9 Kg/m2 (+4,9 Kg/m2). El 54,3% tuvo índice de masa corporal > 25 Kg/m2. La mortalidad general fue 49.2%. Sujetos con sobrepeso y obesidad tuvieron menor mortalidad, OR: 0,48 (IC 95%: 0.34, 0.68; p <0.0001) y OR 0.45 (IC 95 %: 0.28, 0.70; p =0.001) respectivamente, con similar tendencia en el análisis multivariado. Los sujetos con peso bajo tuvieron la mayor mortalidad (OR: 2.12. IC 95%: 0.91 - 5.54. p: 0.097). DISCUSIÓN. Los resultados obtenidos apoyan la teoría de paradoja de obesidad, sin embargo, no se realizó evaluación según los niveles de obesidad. CONCLUSIÓN. La mortalidad en choque séptico es menor en sujetos con sobrepeso y obesidad comparada con sujetos con peso normal o bajo peso.

The obesity paradox proposes that, in certain diseases, patients with obesity have lower mortality. OBJECTIVE. To associate body mass index with 30-day mortality in adults with septic shock. MATERIALS AND METHODS. Observational, analytical, retrospective, multicenter, retrospective study. We analyzed 673 patients with septic shock, admitted to intensive care in two hospitals in the city of Quito - Ecuador, during January 2017 - December 2019. Inclusion criteria: older than 18 years, septic shock, weight, height and vital condition at day 30. Exclusion criteria: Do not resuscitate order, pregnant women, organ donation protocol, palliative care. Variables were collected from the digital and physical medical records of the participating centers. Calculated risk estimates were presented as OR (Odds Ratio) in bivariate analysis and OR Adj (adjusted OR) for multivariate analysis. A p value <0.05 was considered statistically significant. All statistical analyses were performed using R® statistical software (Version 4.1.2). RESULTS. The mean age was 65 years, mean body mass index 25.9 kg/m2 (+4.9 kg/m2). Body mass index > 25 kg/m2 was 54.3%. Overall mortality was 49.2%. Overweight and obese subjects had lower mortality, OR: 0.48 (95% CI: 0.34, 0.68; p<0.0001) and OR 0.45 (95 % CI: 0.28, 0.70; p=0.001) respectively, with similar trend in multivariate analysis. Underweight subjects had the highest mortality (OR: 2.12. 95% CI: 0.91 - 5.54. p: 0.097). DISCUSSION. The results obtained support the obesity paradox theory, however, assessment according to obesity levels was not performed. CONCLUSIONS. Mortality in septic shock is lower in overweight and obese subjects compared to normal weight or underweight subjects.

Manejo ortoplástico de fractura expuesta de pierna grave: a propósito de un caso / Orthoplastic management of severe open fractures: case report / Tratamento ortoplástico das fraturas expostas grave: relato de caso

Las fracturas expuestas de pierna son lesiones frecuentes, sus principales complicaciones son la infección y la dificultad en la consolidación ósea. El abordaje ortoplástico implica llevar a cabo principios y prácticas de ambas especialidades en forma conjunta, evitando el tratamiento por separado de los problemas que surgen de estas lesiones graves y así intentar disminuir al mínimo las complicaciones. Nuestro objetivo es transmitir la importancia del enfoque ortoplástico en las fracturas expuestas. Se reporta el caso de un paciente adulto, con una fractura de pierna, tibia y peroné expuesta, que requirió múltiples procedimientos quirúrgicos en vistas a preservar el miembro. Fueron necesarias variadas estrategias para controlar la infección ósea y reconstruir las partes blandas y óseas. Con el estímulo de la movilidad del tobillo y pie, se logró comenzar a restituir la función del miembro desde el inicio; permitiendo, a las 6 semanas de evolución, el apoyo del miembro mediante una fijación ósea estable. A los 24 meses de seguimiento clínico y radiográfico evidenciamos paciente y familia satisfechos con un excelente resultado funcional según score ASAMI. Se concluye que en pacientes con fracturas expuestas graves, es clave el abordaje ortoplástico para lograr mejores resultados.

Open leg fractures are frequent injuries; the infection and difficulty in bone healing are their main complications. The orthoplastic approach involves carrying out principles and practices of both specialties together, avoiding separate treatment of the problems that arise from these serious injuries and thus minimizing complications. The objective of the article is to convey the importance of the orthoplastic approach in open fractures. We report the case of an adult patient, with an open fractured leg, to required multiple surgical procedures to preserve the limb. Various strategies were necessary to cure the bone infection and reconstruct the soft tissue and bone. The limb function restore was possible promoting the ankle and foot mobility from the beginning and it allowed weight-bearing on the limb through stable bone fixation, at 6 weeks of evolution. We evidenced a patient and family satisfied with an excellent functional result according to the ASAMI score, at 24 moths of clinical and radiographic follow-up. It is concluding that in patients with severe open fractures, the orthoplastic approach is key to obtain better results.

As fraturas expostas da perna são lesões frequentes, suas principais complicações são infecção e dificuldade de consolidação óssea. A abordagem ortoplástica envolve a realização conjunta de princípios e práticas de ambos ases especialidades, evitando o tratamento separado dos problemas decorrentes dessas lesões graves e minimizando assim as complicações. Nosso objetivo é transmitir a importância da abordagem ortoplástica nas fraturas expostas. É relatado o caso de um paciente adulto, com fratura de perna, tíbia e fíbula expostas, necessitando de múltiplos procedimentos cirúrgicos para preservação do membro. Várias estratégias foram necessárias para curar a infecção óssea e reconstruir os tecidos moles e o osso. Foi possível começar a restaurar a função do membro desde o início, com a estimulação da mobilidade do tornozelo e do pé; com 6 semanas de evolução, concedendo cargas ao membro por meio de fixação óssea estável. Apresentou boa evolução, aos 24 meses de acompanhamento clínico y radiográfico, constatamos a satisfação do paciente e família. com um excelente resultado funcional de acordo a pontuação ASAMI. Conclui-sé que em pacientes com fraturas expostas graves, a abordagem ortoplástica é fundamental para obter melhores resultados.

Assessment of oral health condition in recipients of allogeneic hematopoietic cell transplantation

ABSTRACT Objective: The objective of this study was to evaluate the oral health condition and dental treatments performed in patients in pre-allogeneic HCT. Method: The records of patients treated during 2018 at a Brazilian HCT service were reviewed. The following oral health data were obtained: 1. Decayed, missing and filled teeth / correlated index for primary dentition (DMFT/dmft); 2. Quality of oral hygiene and 3. Dental pathologies: 3.1 Periodontal infectious focus, 3.2 Endodontic infectious focus and 3.3 Carie incidence. All dental procedures performed were surveyed. Results: Thirty-three patients were included, with a mean age of 28.42 (±16.37), 20 male (60%) and 13 female. The average DMFT/dmft found in this study was 10.24 (± 8.37), similar to the index found in the population in southeastern Brazil. The younger study population presented a DMFT/dmft considered high, when compared to the general population. A total of 27.2% of the patients had active caries lesions, 33.3%, foci of periodontal infection, 15.1%, endodontic infectious focus and 40%, poor oral hygiene. Almost half of the patients (48.4%) had to undergo dental intervention, 24.2% needing periodontal scaling, 21.2%, fillings and 12.1%, tooth extractions. Conclusion: We conclude that the studied population had an important incidence of dental pathologies and infectious conditions that could complicate throughout HCT, especially in younger patients, therefore presenting a high demand for dental treatment in the pre-HCT. Studies that assess the impact of dental conditioning on the outcomes of HCT with an emphasis on dental infectious complications, days of hospitalization and survival are necessary."

Association between Endodontic Infection, Its Treatment and Systemic Health: A Narrative Review.

The 'Focal Infection Era in Dentistry' in the late 19th and early 20th century resulted in widespread implementation of tooth extraction and limited the progress of endodontics. The theory proposed that bacteria and toxins entrapped in dentinal tubules could disseminate systemically to remote body parts, resulting in many types of degenerative systemic diseases. This theory was eventually refuted due to anecdotal evidence. However, lately there has been increased interest in investigating whether endodontic disease could have an impact on general health. There are reviews that have previously been carried out on this subject, but as new data have emerged since then, this review aims to appraise the available literature investigating the dynamic associations between apical periodontitis, endodontic treatment, and systemic health. The available evidence regarding focal infection theory, bacteraemia and inflammatory markers was appraised. The review also collated the available research arguing the associations of apical periodontitis with cardiovascular diseases, diabetes mellitus, adverse pregnancy outcome and autoimmune disorders, along with the effect of statins and immunomodulators on apical periodontitis prevalence and endodontic treatment prognosis. There is emerging evidence that bacteraemia and low-grade systemic inflammation associated with apical periodontitis may negatively impact systemic health, e.g., development of cardiovascular diseases, adverse pregnancy outcomes, and diabetic metabolic dyscontrol. However, there is limited information supporting the effect of diabetes mellitus or autoimmune disorders on the prevalence and prognosis post endodontic treatment. Furthermore, convincing evidence supports that successful root canal treatment has a beneficial impact on systemic health by reducing the inflammatory burden, thereby dismissing the misconceptions of focal infection theory. Although compelling evidence regarding the association between apical periodontitis and systemic health is present, further high-quality research is required to support and establish the benefits of endodontic treatment on systemic health.

A rare presentation of blastomycosis as a multi-focal infection involving the spine, pleura, lungs, and psoas muscles in a Saudi male patient: a case report.

BACKGROUND: Blastomycosis is a disease caused by the fungus Blastomyces-a thermally dimorphic fungus that can cause granulomatous and/or purulent infection. CASE PRESENTATION: We report here a case of chronic blastomycosis infection in a 24-year-old male patient from Saudi Arabia who presented with recurrent skin abscesses associated with deep-seated and multilevel paraspinal (dorsal and lumbar) collections and bilateral empyema with pulmonary involvement and bilateral psoas abscesses. The diagnosis was made after a CT-guided pleural biopsy revealed the characteristic histopathological findings of blastomycosis. The patient underwent several drainage procedures and was successfully treated with a long-term course of oral itraconazole. CONCLUSIONS: Chronic blastomycosis may have clinical and radiologic features similar to thoracic tuberculosis or malignant disease. There is no definite clinical symptom of blastomycosis, and thus a high degree of suspicion is required for early diagnosis. This case is a rare form of blastomycosis with chronic multifocal purulent infection and is the second case of blastomycosis reported in Saudi Arabia.

Hidrogel sobre material de fixação em cirurgias maxilofaciais / Hydrogel over synthesis material in maxillofacial surgeries

Introdução: O objetivo do presente trabalho é relatar uma série de casos com o uso do hidrogel protetor em cirurgias maxilofaciais. Relato de caso: Cinco pacientes foram submetidos a cirurgias maxilofaciais diversas e uma camada de hidrogel impregnado com antibiótico recobriu o material de síntese. Foi realizada uma revisão de literatura sem restrição de idiomas e tempo de publicação, embora a literatura seja escassa sobre o tema pois trata-se de um produto recente, mas já registrado e liberado para uso nos órgãos competentes brasileiros. Considerações finais: O hidrogel protetor mostrou-se efetivo no tratamento e prevenção de infecções por biofilme e apresentou o efeito secundário inesperado de acelerar a reparação local, inclusive diminuindo o tempo de parestesia. É um produto com resultados promissores e, apesar de alguns estudos confirmarem a sua eficácia como antimicrobiano, futuros estudos são necessários para se avaliar a sua eficácia como acelerador de reparação... (AU)

Introduction: The present paper's objective is to report a series of cases using the protective hydrogel in maxillofacial surgeries. Case report: Five patients underwent several maxillofacial surgeries, and a hydrogel layer covered the synthesis material. A literature review was carried out without restriction of languages and publication time, although the literature is scarce because it is a recent product but already registered and released for use in brazilian competent agencies. Final considerations: The protective hydrogel helps treat and prevent biofilm infections and has the unexpected side effect of speeding up a local repair, including decreasing paresthesia. It is a product with promising results and, although some studies confirm its effectiveness as an antimicrobial, future studies are needed to evaluate its effectiveness as a repair accelerator... (AU)

Enterococcus faecalis in blood cultures-a prospective study on the role of persistent bacteremia.

Enterococcus faecalis can cause infective endocarditis and other complicated infections. We prospectively investigate the incidence of persistent bacteremia with E. faecalis. Of 50 episodes with monomicrobial E. faecalis bacteremia the control blood culture after 48 to 72 hours was positive in 5 episodes (10%) of which 4 had a complicated focal infection.

Influência da periodontite apical crônica no desenvolvimento de cardiomiopatia-induzida em ratos / Influence of chronic apical periodontitis on the development of cardiomyopathy-induced in rats

Estudos têm concluído que infecções dentais como periodontite apical (AP) podem potencializar a patogênese de doenças sistêmicas. A cardiomiopatia dilatada (CMD) é uma condição que afeta a função do miocárdio, dificultando que o coração funcione eficientemente como uma bomba. Existem estudos correlacionando as infecções endodônticas com doenças cardíacas, associando o papel do processo inflamatório e infeccioso endodôntico no desenvolvimento delas, mas não há estudos que avaliem a relação existente entre estas infecções com CMD. O objetivo do trabalho foi avaliar a influência da periodontite apical crônica no desenvolvimento de cardiomiopatia-induzida em ratos medindo o estresse oxidativo e a atividade das enzimas antioxidantes. Quarenta e dois ratos Wistar foram divididos em 4 grupos: Grupo Controle (C) (n=3): sem AP e sem cardiomiopatia-induzida; Grupo AP (n=10): com AP e sem cardiomiopatia-induzida; Grupo CM (n=12): sem AP e com cardiomiopatia-induzida; Grupo APCM (n=17): com AP e com cardiomiopatiainduzida. A AP foi obtida por meio da exposição pulpar dos molares maxilares à cavidade oral por 30 dias. Posteriormente, a CMD foi induzida seguindo a metodologia de O'Connell et al., (2017) usando a indução de "curto prazo". Os animais receberam Doxorrubicina (2,5mg/kg/dose) aplicada em 5 injeções intraperitoneais num período de 2 semanas (dose acumulativa total 12,5mg/kg), os animais do grupo controle e do grupo AP receberam solução salina (0,9% NaCl). Trinta dias após o início da indução da CMD, os animais foram eutanasiados por decapitação através de guilhotina. Para constatar a presença de lesão periapical, as maxilas foram removidas cirurgicamente, dissecadas, fixadas e desmineralizadas para posteriormente serem incluídas e preparadas para análise histológica sob microscopia ótica. Os corações foram coletados, pesados, e imediatamente armazenados para posteriormente realizar a análise bioquímica de peroxidação lipídica (MDA) e de atividade das enzimas antioxidantes (CAT, GPx e SOD). O teste Shapiro-Wilk foi utilizado para determinar a normalidade das amostras; seguido do teste ANOVA de 1 fator com o teste de comparações múltiplas de Bonferroni com um nível de significância de 5%. A peroxidação lipídica aumentou significativamente no grupo APCM com respeito a todos os outros grupos, seguido do grupo CM que teve diferença estatística somente com o grupo AP. No que se refere à enzima antioxidante, os menores valores de atividade foram obtidos no grupo APCM com diferença estatística ao grupo CM. Considerando que os níveis sistêmicos de citocinas e de estresse oxidativo são maiores na presença de AP, e que estes aumentam mais em casos de doenças sistêmicas, provavelmente uma disseminação metastática de produtos da inflamação estariam afetando o tecido miocárdico piorando as condições de CMD no grupo APCM refletindo-se pelo aumento da peroxidação lipídica. Os menores valores da atividade enzimática no grupo APCM pode ser devido a uma depleção nos níveis destas enzimas e/ou na inativação delas por causa de uma maior severidade do dano no miocárdio. Com base nos resultados, conclui-se que a periodontite apical crônica influencia no desenvolvimento de cardiomiopatia-induzida em ratos, através de um aumento do estresse oxidativo e alteração da atividade das enzimas antioxidantes no tecido ventricular.

First case report of Cryptococcus laurentii knee infection in a previously healthy patient.

BACKGROUND: The purpose of this case report was to report a case of Cryptococcus laurentii infection in the left knee of a previously healthy 29 year old male patient. CASE PRESENTATION: After an initial misdiagnosis and 7 months of failed treatment, the patient received nearly a month of treatment with voriconazole (200 mg IV q12 h) and knee irrigation with amphotericin B until the infection was controlled. The treatment continued with fluconazole for nearly 7 months and approximately 5 weeks of antibiotic treatment for a skin bacterial coinfection. In the end, the patient's symptoms disappeared completely, the left knee recovered well, and there was no recurrence of infection. CONCLUSION: The key points of successful treatment in this case were the thorough debridement, the adequate course of knee irrigation with antifungal drugs and more than 6 months of oral antifungal drugs that were able to eradicate the infection.

Life-threatening pathogens in severe/progressive periodontitis: Focal infection risk, future periodontal practice, role of the Periodontology 2000.

Severe/progressive periodontitis is associated with cardiovascular disease, cancer, Alzheimer's disease, and dozens of other serious diseases. Herpesviruses are implicated in severe periodontitis and in specific subsets of each of the above systemic diseases. That both periodontitis and herpesviruses are linked to the same nonoral diseases is consistent with a systemic pathogenic role of periodontal herpesviruses. Effective control of periodontitis-related systemic diseases requires collaboration between dentistry and medicine. Periodontology has emerged as an important preventive medical discipline, and periodontal teaching and practice need to adjust accordingly.

Meyer L. Rhein and Mortarization - Controlling the Root Apex During Focal Infection.

Many stalwarts in the dental profession stood out during the conflagrations of the Focal Infection Era 100 years ago, in an attempt to prevent the wholesale extraction of teeth. One of these individuals, Dr. Meyer L. Rhein, both a physician and dentists often scolded the dental profession for their proclivity in disregarding the biological basis for root canal treatment. His understanding and management of the apical root anatomy challenges did not go unnoticed as he fought to retain teeth regardless of the status of the dental pulp and surrounding supportive structures.

Marcadores predictivos de nefritis focal bacteriana aguda. Estudio multicéntrico casos-control / Predictive markers of acute focal bacterial nephritis. A multicentre case-control study

INTRODUCCIÓN: La nefritis focal bacteriana aguda es una infección intersticial bacteriana, localizada en el parénquima renal, que entraña mayor gravedad que la pielonefritis aguda. El objetivo del estudio es el análisis de factores predictivos que permitan su diagnóstico precoz, fundamental para un adecuado abordaje terapéutico. PACIENTES Y MÉTODOS: Estudio multicéntrico de casos y control retrospectivo. Centros participantes: hospitales de Castellón y Valencia. Periodo de estudio: 2010-2018. Casos: nefritis focal bacteriana. Controles: pielonefritis aguda. RESULTADOS: Se incluyó a un total de 158 pacientes (1:1). La mediana de edad de los casos fue 2 años. El 75% de sexo femenino. No existieron diferencias en la presentación clínica. En el análisis univariante la nefritis focal se relacionó con malformaciones del tracto urinario, bacteriemia, recuento de neutrófilos y la procalcitonina, así como las convulsiones febriles en el límite de la significación. Valores de procalcitonina ≥ 2 ng/ml tiene una OR de 4,9 (IC del 95: 1,77-13,85) de presentar nefritis focal. En el análisis multivariante las malformaciones urológicas mantuvieron la significación estadística y la procalcitonina en el límite de la significación. CONCLUSIONES: Las malformaciones del tracto urinario predisponen al desarrollo de nefritis focal bacteriana. Ante pacientes con infección del tracto urinario y factores predictivos de nefritis focal bacteriana aguda, sería recomendable la realización de una ecografía Doppler renal en fase aguda para un diagnóstico y un tratamiento adecuado

INTRODUCTION: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach. PATIENTS AND METHODS: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010-2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls. RESULTS: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥ 2 ng/ml had an OR of 4.9 (95% CI; 1.77-13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin. CONCLUSIONS: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment

The burden and costs of sepsis and reimbursement of its treatment in a developing country: An observational study on focal infections in Indonesia.

OBJECTIVES: This study aimed to determine the burden of sepsis with focal infections in the resource-limited context of Indonesia and to propose national prices for sepsis reimbursement. METHODS: A retrospective observational study was conducted from 2013-2016 on cost of surviving and non-surviving sepsis patients from a payer perspective using inpatient billing records in four hospitals. The national burden of sepsis was calculated and proposed national prices for reimbursement were developed. RESULTS: Of the 14,076 sepsis patients, 5,876 (41.7%) survived and 8,200 (58.3%) died. The mean hospital costs incurred per surviving and deceased sepsis patient were US$1,011 (SE ± 23.4) and US$1,406 (SE ± 27.8), respectively. The national burden of sepsis in 100,000 patients was estimated to be US$130 million. Sepsis patients with multifocal infections and a single focal lower-respiratory tract infection (LRTI) were estimated as being the two with the highest economic burden (US$48 million and US$33 million, respectively, within 100,000 sepsis patients). Sepsis with cardiovascular infection was estimated to warrant the highest proposed national price for reimbursement (US$4,256). CONCLUSIONS: Multifocal infections and LRTIs are the major focal infections with the highest burden of sepsis. This study showed varying cost estimates for sepsis, necessitating a new reimbursement system with adjustment of the national prices taking the particular foci into account.

[Predictive markers of acute focal bacterial nephritis. A multicentre case-control study]. / Marcadores predictivos de nefritis focal bacteriana aguda. Estudio multicéntrico casos-control.

INTRODUCTION: Acute focal bacterial nephritis is an interstitial bacterial infection, localised in the renal parenchyma, which can be more serious than acute pyelonephritis. The aim of this study is the analysis of predictive factors that may lead to its early diagnosis, which is essential for an adequate therapeutic approach. PATIENTS AND METHODS: A retrospective, multicentre case and control study. The participant centres were hospitals in Castellon and Valencia. The study period was 2010-2018, with the cases being patients with focal bacterial nephritis and the patients with pyelonephritis as controls. RESULTS: A total of 158 (1:1) patients were included. The median age of the cases was 2 years and there were 75% females. There were no differences in the clinical presentation. In the univariate analysis, focal nephritis was associated with malformations of the urinary tract, bacteraemia, the neutrophil count, and procalcitonin, as well as febrile convulsions of borderline significance. Procalcitonin values ≥2 ng/ml had an OR of 4.9 (95%CI; 1.77-13.85) of presenting with focal nephritis. In the multivariate analysis, the urological malformations still maintained statistical significance and borderline significance for procalcitonin. CONCLUSIONS: The urinary tract malformations predispose the development of focal bacterial nephritis. In patients with a urinary tract infection and predictive factors of acute focal bacterial nephritis it would be worthwhile performing a renal Doppler ultrasound in the acute phase for its appropriate diagnosis and treatment.