C-reactive protein concentration as a prognostic factor for inflammation in the management of odontogenic infections

Pediatric Maxillofacial Infections During COVID-19: What Have We Learned?

BACKGROUND

The coronavirus (COVID-19) pandemic significantly affected health care systems worldwide, and the field of dentistry is no exception. Odontogenic infections in pediatric patients pose unique challenges to treatment and diagnosis.

PURPOSE

The purpose of this study was to evaluate the incidence, characteristics, and treatment of pediatric maxillofacial odontogenic infections during COVID-19 compared to pre-COVID-19.

STUDY DESIGN, SETTING, SAMPLE

This retrospective cohort study included all pediatric patients (0-18 years old) who visited the emergency department (ED) at Tzafon Medical Center, Israel, between March 2020 and February 2021 (COVID-19), or between March 2018 and February 2020 (pre-COVID-19), and were diagnosed with maxillofacial odontogenic infections. Patients with missing demographic data and patients who did not complete the medical examination were excluded.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

The exposure variable was the date of presentation, categorized as COVID-19 or pre-COVID-19.

MAIN OUTCOME VARIABLE(S)

The main outcome variables were the proportion of patients diagnosed with odontogenic infections, hospitalization rate, treatment methods, and length of hospital stay.

COVARIATES

Covariates included patient demographics, involved dentition and associated spaces, and the administration of antibiotics before ED arrival.

ANALYSES

The Fisher exact test and Pearson's χ2 test were applied to assess differences in categorical variables. The Wilcoxon rank-sum test was used for independent variables. A logistic regression model was used to predict outcome variables. P values were two-tailed, and statistical significance was defined as P < .05.

RESULTS

The study sample comprised 471 patients: 357 (76%) in the pre-COVID-19 period and 114 (24%) during COVID-19. The relative risk of visits to the ED out of total oral and maxillofacial ED visits was lower during COVID-19 (relative risk = 0.65, P = .0001). The hospitalization rate increased from 72% (257 patients) pre-COVID-19 to 86.8% (99 patients) during the COVID-19 period (P = .001). Length of hospital stay during COVID-19 was significantly shorter than pre-COVID-19 (P < .001).

CONCLUSION AND RELEVANCE

The findings of this study reveal a significant reduction in odontogenic infection incidents referred to the ED during the pandemic. This implies that many of these incidents can be successfully treated in community health care settings without referral to the ED.

To Evaluate the Efficacy of Biomarkers as Monitoring Tool in Patients with Fascial Space Infections of Odontogenic Origin: A Clinical Study

Introduction

The objective was to evaluate the efficacy of biochemical markers (WBC, CRP and fibrinogen) and the course of odontogenic space infections in 50 patients.

Material and Methods

Blood samples were taken preoperatively and postoperatively at day 0, day 4, day 8 and day 12 for measuring the levels of all three biomarkers. The trends of the biomarkers were observed and compared with assessment parameters such as dental etiology, number of teeth involved, number of spaces involved, mouth opening and pain. Active pus discharge, dysphagia, hoarseness and swelling were assessed and scored accordingly.

Results

The data were subjected to paired 't' test, McNemar's and Pearson's bivariate correlation as appropriate. Statistical analysis found strong correlation between laboratory values of markers and parameters used to measure severity of infection. All three biomarkers (WBC, CRP and fibrinogen) are significant markers for hospital stay (p < 0.01). Prospective analysis indicates that only one biomarker cannot be used to rule out specific diagnosis.

Conclusion

The combination of three biochemical markers assessed in the present study (WBC, CRP and fibrinogen) should be used as prognostic factor in assessment, clinical severity and efficacy of treatment regime for patients as these can reliably predict the clinical course of odontogenic infection.

Characterization of patients with odontogenic necrotizing soft tissue infections in the head and neck area. A retrospective analysis

OBJECTIVE

Necrotizing soft-tissue infection (NSTI) in the head and neck area may develop from odontogenic infections. The aim of this study was to characterize patients with NSTI in the head and neck with odontogenic origin in a well-defined prospectively collected cohort.

MATERIAL AND METHODS

Patients with NSTI in the head and neck, hospitalized between 2013 and 2017 at Copenhagen University Hospital and registered in the Scandinavian INFECT database were included. Medical records of identified patients and from the INFECT database were screened for a defined set of data including the primary focus of infection, comorbidities, predisposing factors, clinical and radiographic diagnostics, course of treatment, and treatment outcome.

RESULTS

Thirty-five patients with NSTI in the head and neck area were included in the study. A total of 54% had odontogenic origin, primarily from mandibular molars, and 94% had radiographic signs of infectious oral conditions. Overall, comorbidities were reported in 51% with cardiovascular disease being the most prevalent. In 20%, no comorbidities or predisposing conditions could be identified. The overall 30-day mortality rate was 9%.

CONCLUSIONS

More than half of NSTI cases in the head and neck region had an odontogenic origin, and special attention should be paid to infections related to mandibular molars.

Admission C-reactive protein, WBC count, glucose, and body temperature in severe odontogenic infections: a retrospective study using severity scores

OBJECTIVE

The purpose of this study was to determine whether various serum marker levels (C-reactive protein [CRP], white blood cell [WBC] count, glucose) or body temperature at admission are associated with severity of odontogenic infections.

STUDY DESIGN

This retrospective chart review of patients admitted to the hospital for treatment of severe odontogenic infections (SOIs) over a 5-year period (2016-2020) assigned patients with a severity score (SS) ≥5 to group A and those with an SS <5 to group B. Serum marker levels and temperature at admission were collected, and comparisons between group A and group B were conducted for serum marker levels and body temperature at admission using 2-sample t tests.

RESULTS

The mean serum CRP and temperature at admission between the 2 groups was not statistically significant (P > .05). The mean WBC count and serum glucose at admission between the 2 groups was statistically significant (P = .001 and P = .036, respectively).

CONCLUSIONS

This study demonstrates that serum glucose and WBC at admission are significantly higher in patients with more SOIs. In addition, serum CRP and body temperature at admission are not adequate prognostic indicators of odontogenic infection severity.

Biological factors predicting the length of hospital stay in odontogenic cellulitis

OBJECTIVE

The purpose of this study was to assess whether common biological factors are correlated with a longer hospital stay.

STUDY DESIGN

All patients having odontogenic cellulitis, treated from January 2019 to December 2019 at Lille University Hospital, and requiring surgical drainage under general anesthesia, were included, retrospectively. Data, such as length of hospital stay and biological factors, namely, C-reactive protein (CRP) level, Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score, and bacterial samples were collected.

RESULTS

Significant moderate-strong correlations were found between postoperative length of stay and patients' LRINEC score (r_s = 0.556) and presurgical CRP level (r_s = 0.579). There was a significant moderate correlation between postoperative length of stay and presurgical procalcitonin level (r_s = 0.451), and a weak correlation between postoperative length of stay and presurgical white blood cell count (r_s = 0.282). Linear regression verified CRP as an independent predictor of length of hospital stay, showing a significant linear relationship between them (p < 0.0001). A significant regression equation was found (F(1,65) = 27.089; p = 0.0001), with an R² of 0.294.

CONCLUSION

In this study, CRP was the key biological predictor of length of hospital stay.

STATEMENT OF CLINICAL RELEVANCE

The ability to predict length of hospital stay and identify patients requiring intensive care management, using simple and inexpensive biological parameters (such as CRP), will enable more cost-effective care and efficient hospital bed management.

Chromatographic fractions from Chrysophyllum albidum stem bark boost antioxidant enzyme activity and ameliorate some markers of diabetes complications

BACKGROUND AND AIM

Diabetes, with hyperglycaemia as hallmark, is a global crisis that reduces the antioxidant status and produces complications when poorly managed. The development of complications can be indicated by inflammation, lipid peroxidation and the accumulation of glycation adducts. Thus, the attenuation of hyperglycaemia and boosting of antioxidants status is key in ameliorating markers of diabetes complications. This work evaluated the potency of Chrysophyllum albidum stem bark on some markers of diabetes complications.

EXPERIMENTAL PROCEDURE

A total of 100 female rats (180.80 ± 8.50 g) were assigned into ten groups of ten animals each; control received 1.0 ml of distilled water while those in groups DC, RD, F1, F3, F4, F5, F7, F9, F10 were induced into diabetes by intraperitoneal administration of 120 mg/kg body weight of alloxan and were orally administered distilled water, glibenclamide, 2.5 mg/kg of the chromatographic fractions 1, 3, 4, 5, 7, 9, and 10 respectively, once daily for 14 days. F7 was profiled for its bioactive constituents and the pancreas histology of the rats were examined.

RESULTS

Chromatographic fractions F5 and F7 significantly decreased fasting blood glucose, glycosylated haemoglobin, C-reactive protein, total cholesterol, triglycerides, atherogenic index, malondialdehyde while insulin, high density lipoprotein, catalase, superoxide dismutase activities significantly increased. Fraction F7 revealed eight compounds and restored the distorted pancreas.

CONCLUSION

Fraction F7 ameliorated the markers of diabetes complications considered in this study better than F5, restored the compromised pancreas and can be explored as lead candidate for production of drug for the management of diabetes.

A retrospective analysis of risk factors of oromaxillofacial infection in patients presenting to a hospital emergency ward

Background

The purpose of this study was to review the clinical features of oromaxillofacial infections in patients presenting to a hospital emergency ward, to identify the key factors affecting the requirement for hospitalization, and the potential risk factors predisposing to a prolonged length of hospital stay.

Methods

A retrospective medical record review of the 598 patients treated for oromaxillofacial infection from 2013 to 2017 at the oral and maxillofacial surgery department, Yangsan Pusan National University Hospital, was conducted. The following information was collected from each patient: sex, age, past medical history, site of infection, etiology, admission or outpatient care, level of C-reactive protein (mg/dL), fascial spaces involved, treatment method, and duration of hospitalization. Chi-squared tests were used to identify risk factors, which were further analyzed using multivariable logistic regression.

Results

A total of 606 patients were eligible for inclusion in the study, of which eight were excluded due to having incomplete charts; thus, 598 patients were included: 55% were male, mean patient age was 47.1 ± 19.9 years, and 12.9% of patients were diabetic. Furthermore, 71.2% of patients had infection originating in the mandible; the most common tooth of origin was lower posterior, and 29.8% of patients were hospitalized. Risk factors for hospital admission were elderly patients with concurrent disease, elevated C-reactive protein level, and multiple-space infection in the oromaxillofacial area. The duration of hospitalization was correlated with both diabetes and age.

Conclusions

The requirement for hospital admission is determined by the severity of the infection; even severe infections, once treated with appropriate surgery, have no relation to the length of hospital stay. The important risk factors for increased duration of hospitalization are diabetes mellitus and older age. The understanding of risk factors associated with a prolonged hospital stay during the treatment of oromaxillofacial infection will aid in treatment planning as well as highlight the importance of adequate diabetes control in patients at risk of such infection.