RESUMO
STUDY DESIGN: Psychometric study. OBJECTIVES: The objective of this study was to examine the reliability of the Spinal Cord Independence Measure III (SCIM III) by interview and compare the findings with those of assessment by observation. SETTING: This study was conducted at Loewenstein Rehabilitation Hospital, Israel. METHODS: Thirty-five spinal cord lesion (SCL) patients who underwent rehabilitation at Loewenstein Rehabilitation Hospital in Israel were assessed during the last week before discharge with SCIM III by observation and by interview. Nineteen of the patients were also assessed by interview by a third rater to examine inter-rater reliability. Total agreement, kappa, Bland-Altman plots and intraclass correlation (ICC) were used for comparison between interviewers and between interviews and observations. RESULTS: Total agreement between the interviewers' scores and between interviews and observations was low to moderate (kappa coefficient 0.11-0.80). Bland-Altman analysis revealed good agreement, with low mean difference for almost all SCIM III subscales and total scores, between pairs of interviewers (bias -4.15, limits of agreement -22.51 to 14.19, for total score) and between interviews and observations (bias 1.62, limits of agreement -20.55 to 23.81, for total score). ICC coefficients for the SCIM III subscales and total scores were high (0.637-0.916). CONCLUSION: The findings of this study support the reliability and validity of SCIM III by interview, which appears to be useful for research of SCL patient groups. Individual scoring of SCIM III by interview, however, varied prominently between raters. Therefore, SCIM III by interview should be used with caution for clinical purposes, probably by raters whose scoring deviation, in relation to observation scores, is known.
Assuntos
Atividades Cotidianas/psicologia , Avaliação da Deficiência , Entrevistas como Assunto , Observação , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/psicologia , Idoso , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Traumatismos da Medula Espinal/epidemiologia , Estatística como Assunto , Inquéritos e QuestionáriosRESUMO
STUDY DESIGN: Retrospective observational comparative study. OBJECTIVES: The objectives of this study were to assess the atherosclerosis diseases and risk factors prevalence after spinal cored injury (SCI). SETTING: Loewenstein Rehabilitation Hospital, Israel. METHODS: Data of 154 traumatic and non-traumatic SCI patients were retrospectively collected. Coronary artery disease (CAD), myocardial infarction (MI), hypertension (HT) and risk factors for atherosclerotic diseases were examined after SCI for prevalence and effects, and compared with published corresponding data of the general population. RESULTS: CAD, MI and HT were found in 11.7, 6.7 and 29.2% of 120 patients, aged 53.4±11.1 years, 83.3% males, who survived until the end of the follow-up. Corresponding values for the general population, adjusted for age, gender and years of education, are 8.5, 6.6 and 24.9% in Israel, and 10.2% for CAD and 40.3% for HT, in US. Body mass index>30 increased the odds of acquiring CAD (P=0.016). Hypercholesterolemia and older age at injury increased the hazard for HT (P=0.044; P=0.019, respectively). A steady partner decreased the risk of CAD (P=0.029). HT was more prevalent at T4-T6 than above T4 (52 vs 23.3%, P=0.02). Patients with SCI below T6 had a higher rate of diabetes mellitus, hypercholesterolemia, and past smoking, and fewer years of education than those with SCI above T7 (P=0.016; P=0.032; P=0.034; P=0.014, respectively). CONCLUSION: The prevalence of CAD, HT and some of their risk factors after SCI is generally, but not consistently and not statistically significant, slightly higher than in the corresponding general population. The challenge is to reduce the prevalence of atherosclerotic morbidity after SCI below that in the general population.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Hipertensão/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Adulto , Fatores Etários , Doença da Artéria Coronariana/etiologia , Escolaridade , Feminino , Seguimentos , Humanos , Hipertensão/etiologia , Israel/epidemiologia , Masculino , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/etiologia , Prevalência , Centros de Reabilitação , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Traumatismos da Medula Espinal/complicaçõesRESUMO
BACKGROUND AND PURPOSE: The interictal electroencephalogram (EEG) has an important role in the classification and treatment of epilepsy. In busy EEG laboratories, valuable resources are used in order to comply with current recommendations regarding the length of EEG recordings. Our aim was to examine the time to first interictal epileptiform discharge (IED) in standard and sleep-deprived EEGs. METHODS: Standard and sleep-deprived EEG recordings with IEDs were retrospectively reviewed during a 2-year period. Bedside EEGs and long-term video-EEGs were excluded. IED latency according to EEG type, age group and inpatient/outpatient status was analyzed with the Kaplan-Meier estimator. RESULTS: The study group included 684 patients, 372 (54%) males, aged 0.2-89 years. Standard (n = 316) and sleep-deprived (n = 368) EEGs were performed in 245 inpatients and 439 outpatients. The EEG was requested in 96% of the inpatients following a seizure. Most IEDs were recorded whilst the patients were awake (43%) or drowsy (34%). Ninety percent of the IEDs were recorded within 18.5 min, earlier in standard (14.6 vs. 21.3 min) (P = 0.024) EEGs and in inpatients (14 vs. 21.3 min) (P = 0.002). IED latency was unaffected by age. CONCLUSIONS: Electroencephalogram type and admission status may be used for individual determination of the duration of EEG recording. Reducing the duration of standard and sleep-deprived EEGs may be considered especially in inpatients.
Assuntos
Eletroencefalografia/normas , Epilepsia/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Epilepsia/classificação , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Estimativa de Kaplan-Meier , Laboratórios , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Convulsões/classificação , Convulsões/diagnóstico , Sono , Vigília , Adulto JovemRESUMO
BACKGROUND: Disability scales do not enable the transmission of concise, meaningful and daily function description for clinical purposes. STUDY DESIGN: Cross-sectional statistical analysis of 328 patients' Spinal Cord Independence Measure (SCIM) III item scores (SIS). OBJECTIVE: To develop a concise and clinically interpretable data-based characterization of daily task accomplishment for patients with spinal cord lesions (SCLs). SETTING: Multi-center study at 13 spinal units in 6 countries. METHODS: Patients were grouped into clusters characterized by smaller differences between the patients' SIS within the clusters than between their centers, using the k-medoides algorithm. The number of clusters (k) was chosen according to the percent of SIS variation they explained and the clinical distinction between them. RESULTS: Analysis showed that k=8 SIS clusters offer a good description of the patient population. The eight functional clusters were designated as A-H, each cluster (grade) representing a combination of task accomplishments. Higher grades were usually (but not always) associated with patients implementing more difficult tasks. Throughout rehabilitation, the patients' functional grade improved and the distribution of patients with similar functional grades within the total SCIM III score deciles remained stable. CONCLUSIONS: A new classification based on SIS clusters enables a concise description of overall functioning and task accomplishment distribution in patients with SCL. A software tool is used to identify the patients' functional grade. Findings support the stability and utility of the grades for characterizing the patients' functional status.
Assuntos
Atividades Cotidianas/classificação , Avaliação da Deficiência , Traumatismos da Medula Espinal/reabilitação , Adulto , Idoso , Algoritmos , Estudos Transversais , Incontinência Fecal/etiologia , Incontinência Fecal/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quadriplegia/etiologia , Quadriplegia/reabilitação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicaçõesRESUMO
BACKGROUND: Data showing a role for the mid-thoracic spinal cord (SC) in the control of hemodynamic changes is scarce despite existing evidence for its involvement in autonomic regulation. STUDY DESIGN: On the basis of the open label prospective series comparing three groups. OBJECTIVE: To determine whether the mid-thoracic SC has a role in hemodynamic regulation during head-up tilt (HUT). SETTING: Spinal Research Laboratory, Loewenstein Rehabilitation Hospital. METHODS: A total of 13 healthy control subjects, 10 patients with T(4)-T(6) paraplegia and 11 with C(4)-C(7) tetraplegia were examined during supine rest and during HUT. Heart rate (HR), blood pressure (BP), HR spectral components (lower frequency fluctuation (LF), higher frequency fluctuations (HF) and LF/HF) and cerebral blood flow velocity (CBFV) were continuously measured or calculated. RESULTS: BP response to HUT differed among these groups (P<0.02). During HUT, BP decreased markedly in the tetraplegia group (from a mean value of 81.65 to 67.69 mm Hg), and increased in the control groups (from 92.89 to 95.44 mm Hg) and in the T(4)-T(6) paraplegia group (from 96.24 to 97.86 mm Hg). Significant correlation was found in the control and tetraplegia groups between increases in HR LF/HF and HR at HUT (r>0.7; P<0.01). No such correlation was found in the paraplegia group. HUT effect on HR and CBFV was significant in all groups (P<0.001), but group differences were statistically non-significant. CONCLUSION: Findings were generally compatible with those of comparable previously published studies, but they also support a role for the mid-thoracic SC in hemodynamic regulation, which should be considered in clinical setting and in research.
Assuntos
Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/fisiopatologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Hemodinâmica/fisiologia , Traumatismos da Medula Espinal/fisiopatologia , Adulto , Doenças do Sistema Nervoso Autônomo/etiologia , Doenças Cardiovasculares/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Paraplegia/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Quadriplegia/complicações , Quadriplegia/fisiopatologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnósticoRESUMO
STUDY DESIGN: Controlled experimental human study. OBJECTIVES: To assess insulin resistance (IR) in tetraplegia and paraplegia, and the role of the spinal cord (SC) in glucose regulation. SETTING: Laboratory of Spinal Research, Loewenstein Rehabilitation Hospital. METHODS: Glucose and insulin levels and the heart rate variation spectral components LF (low frequency), HF (high frequency) and LF/HF were studied at supine rest, head-up tilt and after a standard meal in three groups: 13 healthy subjects, 7 patients with T(4)-T(6) paraplegia and 11 patients with C(4)-C(7) tetraplegia. RESULTS: Glucose and insulin increased significantly after the meal in all groups (P<0.001). Glucose increased significantly more in the tetraplegia than in the other groups (P<0.01). Increases in insulin level tended to accompany increases in LF/HF after the meal in the tetraplegia and control groups but not in the paraplegia group. CONCLUSION: Post-prandial IR appears in C(4)-C(7) but not in T(4)-T(6) SC injury. The results of the study, combined with previously published findings, are consistent with the hypotheses that IR is related to activation of the sympathetic nervous system, and that below T(4) the mid-thoracic SC is involved in the regulation of glucose and insulin levels.
Assuntos
Glicemia/metabolismo , Resistência à Insulina/fisiologia , Paraplegia/metabolismo , Quadriplegia/metabolismo , Traumatismos da Medula Espinal/metabolismo , Adulto , Glicemia/biossíntese , Vértebras Cervicais/lesões , Feminino , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Hiperglicemia/metabolismo , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Quadriplegia/complicações , Medula Espinal/metabolismo , Medula Espinal/patologia , Traumatismos da Medula Espinal/complicações , Vértebras Torácicas/lesões , Adulto JovemRESUMO
STUDY DESIGN: Multicenter international cohort study. OBJECTIVE: The objective of this study was to establish target values for Spinal Cord Independence Measure (SCIM) III scoring in rehabilitation for clinically complete spinal cord lesion (SCL) neurological levels. SETTING: In total, 13 spinal cord units in six countries from North America, Europe and the Middle East were taken. METHODS: Total SCIM III scores and gain at discharge from rehabilitation were calculated for SCL levels in 128 patients with American Spinal Injury Association Impairment Scale (AIS) grade A on admission to rehabilitation. RESULTS: Median, quartiles, mean and s.d., values of discharge SCIM III scores and SCIM III gain for the various SCL levels are presented. Total SCIM III scores and gain were significantly correlated with the SCL level (r=0.730, r=0.579, P<0.001). CONCLUSIONS: Calculated discharge SCIM III scores can be used as target values for functional achievements at various neurological levels in patients after AIS A SCL. They are generally, but not always, inversely correlated with SCL level.
Assuntos
Avaliação da Deficiência , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Adulto , Europa (Continente) , Humanos , Cooperação Internacional , Pessoa de Meia-Idade , Oriente Médio , Exame Neurológico , América do Norte , Recuperação de Função Fisiológica/fisiologia , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/reabilitação , Adulto JovemRESUMO
STUDY DESIGN: A multi-center international cohort study. OBJECTIVE: To evaluate the reliability and validity of the third version of the Spinal Cord Independence Measure (SCIM III), separately for patients with traumatic spinal cord lesions (SCLs). SETTING: A total of 13 spinal cord units in six countries from North America, Europe and the Middle-East. METHODS: SCIM III and Functional Independence Measure (FIM) were assessed for 261 patients with traumatic SCLs, on admission to rehabilitation and before discharge, by two raters. Conventional statistical measures were used to evaluate the SCIM III reliability and validity. RESULTS: In almost all SCIM III tasks, the total agreement between the paired raters was >80%. The κ coefficients were all >0.6 and statistically significant. Pearson's coefficients of the correlations between the paired raters were >0.9, the mean differences between raters were nonsignificant and the intraclass correlation coefficients (ICCs) were ≥ 0.95. Cronbach's α values for the entire SCIM III scale were 0.833-0.835. FIM and SCIM III total scores were correlated (r=0.84, P<0.001). SCIM III was more responsive to changes than FIM. In all subscales, SCIM III identified more changes in function than FIM, and in 3 of the 4 subscales, differences in responsiveness were statistically significant (P<0.02). CONCLUSION: The results confirm the reliability and validity of SCIM III for patients with traumatic SCLs in a number of countries.
Assuntos
Avaliação da Deficiência , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários/normas , Atividades Cotidianas/classificação , Adulto , Estudos de Coortes , Feminino , Humanos , Vida Independente/normas , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: Compare rehabilitation after spinal cord lesions (SCL) in different countries. DESIGN: Multicenter comparative study. SETTING: Four spinal rehabilitation units, in Denmark, Russia, Lithuania and Israel. SUBJECTS: 199 SCL patients. INTERVENTIONS: Information was collected about unit properties, rehabilitation objectives, American Spinal Injury Association (ASIA) scale and spinal cord independence measure (SCIM) assessments, and patient data. chi (2)-test, t-test, ANOVA and ANCOVA were used for statistical analysis. MAIN OUTCOME MEASURES: Time from lesion onset to admission for rehabilitation (TAR), length of stay in rehabilitation (LOS), SCIM and spinal cord ability realization measurement index (SCI-ARMI) scores, SCIM gain, SCI-ARMI gain and rehabilitation efficiency (RE). RESULTS: Differences were found between the units in rehabilitation objectives, facilities and special equipment for rehabilitation. Staff/bed ratio was 1.7 in Lithuania and Denmark, 1.1 in Israel and 0.9 in Russia. Russian patients were the youngest and had the most severe lesions among participating units. Admission SCIM and SCI-ARMI were the lowest in Israel: 25.1+/-17.2 and 34.3+/-17.3. TAR was highest in Russia (12.4 month) and lowest in Israel (2 weeks; P<0.01). LOS was longest in Denmark (176.9 days; P<0.001). SCIM score at the end of rehabilitation was highest in Denmark (67.3+/-23). SCIM gain and SCI ARMI gain were highest in Israel (36.9+/-18.3 and 38.5+/-19.4, respectively) and lowest in Russia (P<0.001). RE was highest in Lithuania and lowest in Denmark (P<0.001). CONCLUSIONS: In the participating units, SCL rehabilitation outcomes depend on SCL severity and unit-specific properties. A moderately delayed rehabilitation with long LOS achieved high functioning, and early or slightly delayed rehabilitation combined with shorter LOS achieved high functional gain or efficiency.
Assuntos
Unidades Hospitalares/estatística & dados numéricos , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/reabilitação , Dinamarca , Avaliação da Deficiência , Feminino , Humanos , Israel , Tempo de Internação , Lituânia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Federação Russa , Tempo , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
PURPOSE: To examine the third version of the Spinal Cord Independence Measure (SCIM III) for reliability and validity in a multi-center cohort study. METHOD: Four hundred and twenty-five patients with spinal cord lesions from 13 spinal cord units in six countries from three continents were assessed with SCIM III and the Functional Independence measure (FIM) on admission to rehabilitation and before discharge. RESULTS: Total agreement between raters was above 80% in most SCIM III tasks, and all kappa coefficients were statistically significant (P<0.001). The coefficients of Pearson correlation between the paired raters were above 0.9, and intraclass correlation coefficients were above 0.94. Cronbach's alpha was above 0.7. The coefficient of Pearson correlation between FIM and SCIM III was 0.790 (P<0.01). SCIM III was more responsive to changes than FIM in the subscales of Respiration and sphincter management and Mobility indoors and outdoors. CONCLUSIONS: The results support the reliability and validity of SCIM III in a multi-cultural setup. Despite several limitations of the study, the results indicate that SCIM III is an efficient measure for functional assessment of SCL patients and can be safely used for clinical and research trials, including international multi-center studies.
Assuntos
Avaliação da Deficiência , Doenças da Medula Espinal/reabilitação , Atividades Cotidianas , Estudos de Coortes , Defecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Paraplegia/reabilitação , Quadriplegia/reabilitação , Reprodutibilidade dos Testes , Respiração , Autocuidado , MicçãoRESUMO
PURPOSE: Telomerase is considered a molecular marker for malignancy. The aim of this study was to determine telomerase activity (TA) as a prognostic factor at diagnosis and as a marker for minimal residual disease during therapy and follow-up in nonmetastatic Ewing family of tumors (EFT). PATIENTS AND METHODS: Primary tumor specimens and 97 peripheral blood (PBL) samples from 31 EFT patients were analyzed for TA by the Telomeric Repeat Amplification Protocol (TRAP assay). The telomerase catalytic subunit (human telomerase reverse transcriptase [hTERT]) gene expression was evaluated by quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and telomere length was determined by Southern blotting. The presence of the EFT chimeric transcripts was analyzed by RT-PCR. Correlations with progression-free survival were evaluated. RESULTS: At diagnosis, TA in primary tumors did not correlate with outcome. During therapy and follow-up, highly significant correlation was observed between high TA in PBL samples and adverse prognosis (P <.0001). None of the patients harboring low TA progressed, with a long follow-up (median, 60 months) and a progression-free survival (PFS) of 100%. In nine patients, high TA actually could predict relapse, long before overt clinical relapse. The group of patients with high TA and positive RT-PCR had the most adverse outcome; PFS of 20% (P =.0025). TA was found to be a better prognostic factor than RT-PCR and histopathologic response at surgery. CONCLUSION: The results suggest that TA is a significant prognostic variable, superior to the established clinical prognostic parameters during therapy and tumor surveillance. It could be used in combination with RT-PCR for a new risk classification.
Assuntos
Sarcoma de Ewing/enzimologia , Telomerase/sangue , Adolescente , Biomarcadores Tumorais/sangue , Criança , Proteínas de Ligação a DNA , Feminino , Seguimentos , Humanos , Masculino , Neoplasia Residual/sangue , Prognóstico , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Sarcoma de Ewing/diagnósticoRESUMO
In this study we estimate the frequency of carriers of chronic (type I) Gaucher disease among Ashkenazi Jews by examining the glucocerebrosidase activity in leukocytes in a population of 635 blood donors (441 Ashkenazi) and 57 obligatory heterozygotes. Estimation using the defect in the enzyme glucocerebrosidase (beta-glucosidase) in leukocytes is complicated by the existence of considerable overlap between enzyme activity in normals and in heterozygotes. The assay was carried out with a natural substrate labeled with 14C. Discriminant analysis was used to establish an optimal cutoff point between the obligatory heterozygotes and normal (non-Ashkenazi) subjects for the purpose of estimating frequency of carriers. Applied to the Ashkenazi group, the cutoff point identified 3.17% as heterozygotes. Corrected for errors in classification, the carrier rate was estimated as 4.67%. This figure is in good agreement with a carrier rate of 4% estimated from the number of known cases of clinical Gaucher disease ascertained in Israel.
Assuntos
Doença de Gaucher/etnologia , Doença de Gaucher/enzimologia , Judeus/classificação , Etnicidade , Doença de Gaucher/epidemiologia , Triagem de Portadores Genéticos , Alemanha/etnologia , Glucosilceramidase/sangue , Humanos , Israel , Leucócitos/enzimologiaRESUMO
Serum from young normal BALB/c mice was found to contain IgM antibodies able to mediate complement-dependent lysis of certain syngeneic or allogeneic tumor target cells. The titer of such naturally occurring antitumor antibodies ( NATA ) was found to increase with aging. A longitudinal serological study comparing the cytotoxicity potential of NATA from normal and from urethan-treated BALB/c mice was performed. It was found that urethan-treated mice that did not develop primary lung-adenomas within the duration of the experiment had significantly lower NATA titers, against one out of 4 target cells assayed, than urethan-treated animals that developed lung adenomas. This difference was evident in two independent experiments. The results suggested that the lower NATA activity of the urethan-treated mice that did not develop tumors existed even before exposure to the carcinogenic insult. This raises the possibility that certain populations could be segregated according to their natural antibody profile into those individuals which will develop primary tumors within a certain period if exposed to a subthreshold amount of carcinogen, and those which will not.
Assuntos
Anticorpos Antineoplásicos/análise , Neoplasias Experimentais/imunologia , Uretana , Adenoma/imunologia , Animais , Citotoxicidade Imunológica , Feminino , Imunidade Inata , Neoplasias Pulmonares/imunologia , Camundongos , Camundongos Endogâmicos BALB C , Neoplasias Experimentais/induzido quimicamenteRESUMO
The purpose of the present investigation was to test the association between the BANA test (Perioscan, Oral-B), and oral malodor parameters. The subject population consisted of 52 Israeli adults, 43 of whom complained of oral malodor. Oral malodor measurements consisted of peak and steady-state volatile sulphide measurement by a portable sulphide monitor (Interscan Corp., model 1170), as well as organoleptic measurements of malodor from whole mouth, tongue, and saliva. Samples for the BANA test were obtained from four loci (shallow pocket, deep pocket, tongue dorsum, saliva); results were scored as negative (0), weak (1), or strong (2). BANA scores were significantly associated with odor-judge ratings, with the highest association obtained when BANA saliva scores and odor-judge saliva assessment were compared (r = 0.500; p < 0.001). BANA tests from the different loci were not significantly associated with sulphide monitor levels. Stepwise multiple-regression analysis of odor-judge measurements in terms of sulphide levels and average BANA scores showed that both log peak sulphide levels as well as BANA scores were significantly factored into the equations, yielding, in all cases, highly significant correlations (multiple r = 0.57, 0.50, and 0.59, respectively, with significance levels of 0.0001, 0.001, and < 0.0001, for whole mouth, tongue, and saliva malodor, respectively). The results suggest that the BANA scores are associated with a component of oral malodor which is independent of volatile sulphide measurements and suggest its use as an adjunct test to volatile sulphide measurement.
Assuntos
Benzoilarginina-2-Naftilamida , Ensaios Enzimáticos Clínicos , Halitose/diagnóstico , Bolsa Periodontal/microbiologia , Compostos de Sulfidrila/análise , Adolescente , Adulto , Análise de Variância , Bacteroides/enzimologia , Criança , Placa Dentária/microbiologia , Feminino , Halitose/enzimologia , Halitose/microbiologia , Humanos , Sulfeto de Hidrogênio/análise , Sulfeto de Hidrogênio/metabolismo , Pessoa de Meia-Idade , Porphyromonas gingivalis/enzimologia , Análise de Regressão , Saliva/microbiologia , Compostos de Sulfidrila/metabolismo , Língua/microbiologia , Treponema/enzimologiaRESUMO
Whereas previous studies have shown correlations between volatile sulphur compounds (VSC) and bad breath levels, it is probable that other compounds found in the oral cavity may contribute to oral malodor. In the present investigation, the possibility that diamines (cadaverine and putrescine) are associated with oral malodor parameters was assessed. Saliva samples from 52 subjects were analyzed for cadaverine and putrescine by HPLC. Oral malodor of whole mouth, tongue, and saliva of the subjects was recorded by an experienced judge on a continuous 10-cm scale; peak and steady-state VSC intraoral levels were measured by the Interscan 1170 sulphide monitor. Log-transformed VSC and diamine levels were compared with odor judge measurements by Pearson analysis and stepwise forward multiple regression. Putrescine scores were not significantly associated with odor judge parameters or with VSC levels (p > 0.1). However, highly significant correlations (p < or = 0.003) were found between cadaverine levels and all three odor judge assessments. In contrast, associations between cadaverine and VSC measurements were non-significant. In an attempt to correlate odor judge results in terms of both VSC and diamines, we carried out stepwise forward multiple regression. Results showed that VSC and cadaverine both factor significantly in explaining each of the odor judge measurements, with multiple r values ranging from 0.545 (p = 0.0002) to 0.604 (p < 0.0001). The results suggest that cadaverine levels are associated with oral malodor, and that this association may be independent of VSC.
Assuntos
Cadaverina/metabolismo , Placa Dentária/microbiologia , Halitose/etiologia , Saliva/química , Adolescente , Adulto , Benzoilarginina-2-Naftilamida , Cadaverina/análise , Carboxiliases/metabolismo , Criança , Cromatografia Líquida de Alta Pressão , Placa Dentária/complicações , Índice de Placa Dentária , Feminino , Halitose/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ornitina Descarboxilase/metabolismo , Índice Periodontal , Putrescina/análise , Análise de Regressão , Compostos de Sulfidrila/análiseRESUMO
Bad breath (halitosis, oral malodor) is a common condition, usually the result of microbial putrefaction within the oral cavity. Often, people suffering from bad breath remain unaware of it, whereas others remain convinced that they suffer from foul oral malodor, although there is no evidence for such. The purpose of the present investigation was to determine whether objective self-measurement of oral malodors is possible. Each of 52 volunteers was asked to sample the odor from his/her mouth, tongue, and saliva. Results were compared with (i) self-assessments prior to (preconception) and following (post-measurement) self-measurements; (ii) odor judge scores; (iii) dental-measurements (plaque index, gingival index, and probing depth); (iv) volatile sulphide levels; (v) salivary cadaverine levels; and (vi) intra-oral trypsin-like activity. Among the self-measurements, only saliva self-scores yielded significant correlations with objective parameters. Despite the partial objectivity of saliva self-estimates, subsequent post-measurement self-assessments failed to correlate with objective parameters. The results suggest that (i) preconceived notions confound the ability to score one's own oral malodors in an objective fashion; and (ii) partial objectivity can be obtained in the case of saliva self-measurement, presumably because the stimulus is removed from the body proper.
Assuntos
Halitose/psicologia , Autoavaliação (Psicologia) , Adulto , Benzoilarginina-2-Naftilamida , Cadaverina/análise , Índice de Placa Dentária , Feminino , Halitose/diagnóstico , Humanos , Masculino , Transtornos Neuróticos/diagnóstico , Índice Periodontal , Determinação da Personalidade , Escalas de Graduação Psiquiátrica , Análise de Regressão , Saliva/química , Saliva/enzimologia , Olfato , Sulfetos/análise , Língua , Tripsina/metabolismoRESUMO
Multiple parameters of immune function were measured serially before and one and five weeks following operation in 14 patients with fibrocystic disease of the breast (Group A) and in 20 patients with stage 1-2 infiltrating duct carcinoma (Group B). These parameters included the following: WBC, total number and percentage of lymphocytes, numbers of B cells, T cells, T-active, T-helper and T-suppressor cells and the ratio between the latter as well as spontaneous suppressor or helper activity and the graft-versus-host reaction. Prior to operation no statistically significant difference was found between the two groups except for the number of T-helper cells, which was higher in Group B (p less than 0.05), and the spontaneous suppressor activity, which was higher in Group B (p less than 0.05). The finding of such a high percentage (80%) of negative graft-versus-host reactions five weeks after operation together with the high suppressor activity may indicate the presence of tumor micrometastases. The burden of surgery and general anesthesia was stronger in Group B, with a pronounced difference found between the groups (p = 0.0005), but the interaction between the influence of time (surgery and anesthesia) and the groups was not as great (p = 0.4864) and was found to be different for each group.
Assuntos
Neoplasias da Mama/imunologia , Doença da Mama Fibrocística/imunologia , Subpopulações de Linfócitos/imunologia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/imunologia , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Doença da Mama Fibrocística/cirurgia , Humanos , Tolerância Imunológica , Imunidade CelularRESUMO
Few scientific investigations have addressed the ability of mouthrinses to reduce oral malodor for periods longer than 3 hours. In the present report, we have employed simple, recently described techniques to assess the day-long reduction in oral malodor of a novel 2-phase oil:water mouthrinse (TPM), as compared to a corresponding placebo rinse, and to a commercial 0.2% chlorhexidine mouthrinse. Sixty dental students were divided randomly into 3 groups, and instructed to use one of the rinses prior to bedtime and the following morning. Measurements carried out in the late afternoon, about 8 to 10 hours following rinsing, were compared with baseline measurements carried out in the late afternoon of the previous day. Volatile sulphide levels were measured using a portable industrial sulphide monitor. Microbial levels were estimated using a simple rinsing technique employing sterilized milk. These quantitative techniques were corroborated by organoleptic (hedonic) ratings of a single odor judge. Both TPM and chlorhexidine brought about significant decreases in volatile sulphides (P less than 0.05) as compared to the placebo group. These results were corroborated by the organoleptic data. Similarly, both chlorhexidine and TPM were highly effective in reducing microbial levels as measured by the rinsing technique, in comparison to the placebo group. Chlorhexidine appeared to be more effective than TPM in all measurement categories, although only in the case of microbial activity was there a significant (P less than 0.05) difference between the two groups.
Assuntos
Cetilpiridínio/uso terapêutico , Clorexidina/análogos & derivados , Halitose/prevenção & controle , Antissépticos Bucais/uso terapêutico , Óleos Voláteis/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Cetilpiridínio/administração & dosagem , Clorexidina/administração & dosagem , Clorexidina/uso terapêutico , Contagem de Colônia Microbiana , Halitose/metabolismo , Halitose/microbiologia , Humanos , Sulfeto de Hidrogênio/análise , Óleos Voláteis/administração & dosagem , Azeite de Oliva , Placebos , Óleos de Plantas/administração & dosagem , Óleos de Plantas/uso terapêutico , Compostos de Sulfidrila/análise , Sulfetos/análise , ÁguaRESUMO
Previous studies have established that hydrogen sulphide and mercaptans are the primary components of halitosis (bad breath). In the present investigation, we report a simple, rapid technique for measurement of halitosis-related sulphides. The technique is based on a portable instrument generally used for environmental safety applications. Seventy-five volunteers were measured using this technique, and the results (in peak ppb hydrogen sulphide equivalents) compared with organoleptic assessment by 7 judges. A highly significant overall correlation (r = 0.603; P less than 0.001) was obtained between these 2 methods. Moreover, in most cases, the organoleptic ratings of the individual judges correlated more highly with sulphide monitor values than with one another. The simplicity of the technique suggests its use in clinical studies as well as in diagnosis and treatment of patients with this complaint.
Assuntos
Monitoramento Ambiental/instrumentação , Halitose/metabolismo , Sulfetos/análise , Adolescente , Adulto , Idoso , Criança , Desenho de Equipamento , Feminino , Humanos , Sulfeto de Hidrogênio/análise , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Odorantes/análise , Olfato , Compostos de Sulfidrila/análiseRESUMO
The purpose of the study was to examine the anti-malodor, anti-gingivitis, and plaque reducing properties of a 2 phase oil:water mouthrinse compared with a control mouthrinse. Fifty subjects rinsed with one of the two rinses for 30 seconds twice a day over 6 weeks, while continuing their normal oral hygiene habits. Measurements were made at time zero (prior to beginning the rinsing regimen), and > or = 9 hours following rinsing, at intervals of 1, 3, and 6 weeks. Malodor of whole mouth, as well as tongue dorsum anterior and posterior, was assessed on a 0 to 5 semi-integer scale by two odor judges. Volatile sulphide compounds (VSC) were determined using a sulphide monitor. Gingival, plaque, and bleeding indices were recorded for Ramfjord teeth. Oral microbial levels were assessed using the oratest. Salivary levels of diamines (putrescine and cadaverine) were analyzed by HPLC. Results were analyzed by 2-tailed covariant ANOVA, with the time zero value as covariant. Dramatic improvements were observed in parameters associated with malodor, periodontal health, plaque accumulation, and microbial levels in both groups. As compared to time zero scores, whole mouth odor, tongue dorsum anterior and posterior odors decreased continuously over time, attaining 80%, 79% and 70%, reductions, respectively following 6 weeks, in the 2-phase mouthrinse group, versus 70%, 77% and 59% for the control group. For whole mouth and tongue dorsum posterior, the reductions observed in the 2-phase mouthrinse group were significantly greater than those obtained with the control mouthrinse (P = 0.026 and P = 0.025, respectively), suggesting that the 2-phase mouthrinse is superior to the control mouthrinse in long-term reduction of oral malodor. For bleeding index, gingival index, oral microbial levels, and VSC, differences between the groups were not significant. Diamine levels were not significantly reduced in either group. The control mouthrinse reduced plaque index more significantly than the 2-phase mouthrinse (P < 0.005). The results of this randomized clinical trial suggest that the 2-phase oil:water mouthrinse formulation is superior to the control mouthrinse in long-term reduction of oral malodor.