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Gupta A, Saleena LM, Kannan P, Shivachandran A. The impact of oral diseases on respiratory health and the influence of respiratory infections on the oral microbiome. J Dent 2024; 148:105213. [PMID: 38936454 DOI: 10.1016/j.jdent.2024.105213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE The objective of this review is to examine the relationship between oral diseases and respiratory health, investigating how oral microbiome disruptions contribute to respiratory tract infections. Additionally, it aims to explore the impact of respiratory disease symptoms and treatments on the oral microbiome. DATA SOURCES The literature utilized in this review was sourced from studies focusing on the correlation between oral health and respiratory infections, spanning a period of 40 years. Various databases and scholarly sources were likely consulted to gather relevant research articles, reviews, and clinical studies. STUDY SELECTION This review summarizes four decades-long research, providing insights into the intricate relationship between oral and respiratory health. It delves into how oral diseases influence respiratory tract conditions and vice versa. The selection process likely involved identifying studies that addressed the interaction between oral microbiome disruptions and respiratory complications. CONCLUSION Oral diseases or poor oral habits have been known to increase the risk of getting respiratory infections. Modern techniques have demonstrated the relationship between oral disease and respiratory tract infections like influenza, chronic obstructive pulmonary diseases, asthma, and Pneumonia. Apart from that, the medications used to treat respiratory diseases affect oral physiological factors like the pH of saliva, and saliva flow rate, which can cause significant changes in the oral microbiome. This review provides regular oral hygiene and care that can prevent respiratory health and respiratory infections. CLINICAL SIGNIFICANCE Understanding the intricate relationship between oral health and respiratory infections is crucial for healthcare providers. Implementing preventive measures and promoting good oral hygiene habits can reduce respiratory tract infections and improve overall respiratory health outcomes.
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Affiliation(s)
- Annapurna Gupta
- Department of Biotechnology, School of Bioengineering, College of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, Tamil Nadu 603203, India
| | - Lilly M Saleena
- Department of Biotechnology, School of Bioengineering, College of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, Tamil Nadu 603203, India.
| | - Priya Kannan
- Department of Biotechnology, School of Bioengineering, College of Engineering and Technology, SRM Institute of Science and Technology, SRM Nagar, Kattankulathur, Kanchipuram, Chennai, Tamil Nadu 603203, India
| | - A Shivachandran
- Department of Oral Pathology, SRM Dental College and Hospital, SRM Institute of Science and Technology, SRM Nagar Kattankulathur, Kanchipuram, Chennai, Tamil Nadu 603203, India
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Ferhatoglu MF, Sahin OZ, Kivilcim T, Gurkan A. The positive effects of preoperative chlorhexidine rinse to reduce postoperative pneumonia after kidney transplantation surgery. Surgeon 2024:S1479-666X(24)00066-0. [PMID: 38981842 DOI: 10.1016/j.surge.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Postoperative pneumonia is one of the most observed hospital-acquired infections and increases the postoperative mortality rate. Further, it drives the healthcare systems under a severe financial burden. Preventing postoperative pneumonia is an incredibly challenging issue for clinicians. Since immunosuppression therapy, the patients who had kidney transplants are more vulnerable to postoperative infections. There is no data in the scientific literature focusing on the effects of preoperative oral care with chlorhexidine antiseptic solutions on postoperative pneumonia in kidney transplantation surgery cases. In the present research, we studied this topic. METHODS A prospective, randomized clinical trial was conducted at our institution between August 2020 and August 2022. Group A: Received 0.12 % chlorhexidine oral rinse preoperatively; Group B: Not received 0.12 % chlorhexidine oral rinse preoperatively. We analyzed the differences between the two trial groups using a chi-square or t-test. The Mann-Whitney U test was used for the categorical data. RESULTS Nine patients (17.6 %) were diagnosed with postoperative pneumonia in Group A and fourteen (25.9 %) in Group B (p < 0.05). Hospitalization time of Group B was prolonged (p < 0.05). In multivariate analysis, significant risk factors associated with postoperative pneumonia were advanced age, diabetes mellitus, smoking, delayed graft function and not gargling with 0.12 % chlorhexidine (p < 0.05). CONCLUSIONS To reduce postoperative pneumonia risk in patients undergoing kidney transplantation surgery, an oral health protocol including 0.12 % chlorhexidine mouth rinse seems beneficial.
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Affiliation(s)
| | - Osman Z Sahin
- Istanbul Okan University, Faculty of Medicine, Department of Nephrology, Istanbul, Turkey
| | - Taner Kivilcim
- Istanbul Okan University, Faculty of Medicine, Department of Surgery, Istanbul, Turkey
| | - Alp Gurkan
- Istanbul Okan University, Faculty of Medicine, Department of Surgery, Istanbul, Turkey
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Papalexopoulos D, Partalis C, Lampropoulos P, Artopoulou II, Sykaras N. Incorporating Stud Attachments in the Bar Design for an Implant-Supported Overdenture. Case Rep Dent 2024; 2024:2818034. [PMID: 38933360 PMCID: PMC11208102 DOI: 10.1155/2024/2818034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/12/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Bone resorption following tooth loss might compromise retention, stability, and support of conventional removable prostheses, and for this reason, implant-supported overdentures are suggested as a viable alternative for completely edentulous patients. Bars, telescopic attachments, or stud attachments have been used to provide retention through a different mechanism of action based on specific design characteristics. The purpose of this report is to thoroughly describe the applied protocol for the fabrication of an implant overdenture supported by two bars incorporating stud attachments. A 67-year-old male patient presented to the Postgraduate Clinic of the National and Kapodistrian University in Athens seeking dental rehabilitation. The remaining teeth were characterized with poor prognosis, mainly due to their periodontal status. The proposed treatment plan included the placement of four implants in the maxilla and two implants in the mandible and the fabrication of implant-supported overdentures. The diagnostic stages revealed adequate prosthetic space that would enable the fabrication of a bar substructure for the maxillary overdenture. To combine the benefits of bars and stud attachments, two bars with four attachments were fabricated. Evaluation of the delivered prosthesis revealed adequate retention, support, and stability achieved with minimal palatal coverage. Patient's reported satisfaction and quality of life were increased. Recall appointments at one, six, and twelve months did not reveal any adverse effects or patient's complaints. According to the present case report, different types of attachments may be used after careful study of each case. More studies are needed to report on different aspects of the chosen treatment plan.
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Affiliation(s)
- Dimokritos Papalexopoulos
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Christos Partalis
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Panagiotis Lampropoulos
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Ioli-Ioanna Artopoulou
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
| | - Nikitas Sykaras
- Department of ProsthodonticsSchool of DentistryNational and Kapodistrian University of Athens, Zografou, Greece
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Wada E, Ito C, Shinohara M, Handa S, Maetani M, Yasugi M, Miyake M, Sakamoto T, Yazawa A, Kamitani S. Prunin Laurate Derived from Natural Substances Shows Antibacterial Activity against the Periodontal Pathogen Porphyromonas gingivalis. Foods 2024; 13:1917. [PMID: 38928857 PMCID: PMC11202431 DOI: 10.3390/foods13121917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/03/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Periodontal disease is an inflammatory disease caused by infection with periodontopathogenic bacteria. Oral care is essential to prevent and control periodontal disease, which affects oral and systemic health. However, many oral hygiene products currently on the market were developed as disinfectants, and their intense irritation makes their use difficult for young children and older people. This study investigated the antibacterial effects of prunin laurate (Pru-C12) and its analogs on periodontopathogenic bacteria, Porphyromonas gingivalis (P. gingivalis). Pru-C12 and its analogs inhibited in vitro bacterial growth at more than 10 μM and biofilm formation at 50 µM. Among its analogs, only Pru-C12 showed no cytotoxicity at 100 µM. Three of the most potent inhibitors also inhibited the formation of biofilms. Furthermore, Pru-C12 inhibited alveolar bone resorption in a mouse experimental periodontitis model by P. gingivalis infection. These findings may be helpful in the development of oral hygiene products for the prevention and control of periodontal disease and related disorders.
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Affiliation(s)
- Erika Wada
- Nutrition Support Course, Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (A.Y.)
| | - Chiharu Ito
- Division of Clinical Nutrition, School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (M.M.)
| | - Mai Shinohara
- Nutrition Support Course, Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (A.Y.)
| | - Satoshi Handa
- Graduate School of Agriculture, Osaka Metropolitan University, Sakai 599-8531, Osaka, Japan; (S.H.); (T.S.)
| | - Miki Maetani
- Division of Clinical Nutrition, School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (M.M.)
| | - Mayo Yasugi
- Graduate School of Veterinary Science, Osaka Metropolitan University, Izumisano 598-8531, Osaka, Japan; (M.Y.); (M.M.)
| | - Masami Miyake
- Graduate School of Veterinary Science, Osaka Metropolitan University, Izumisano 598-8531, Osaka, Japan; (M.Y.); (M.M.)
| | - Tatsuji Sakamoto
- Graduate School of Agriculture, Osaka Metropolitan University, Sakai 599-8531, Osaka, Japan; (S.H.); (T.S.)
| | - Ayaka Yazawa
- Nutrition Support Course, Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (A.Y.)
- Division of Clinical Nutrition, School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (M.M.)
- Department of Nutrition, Graduate School of Human Life & Ecology, Osaka Metropolitan University, Habikino 583-8555, Osaka, Japan
| | - Shigeki Kamitani
- Nutrition Support Course, Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (A.Y.)
- Division of Clinical Nutrition, School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino 583-8555, Osaka, Japan (M.M.)
- Department of Nutrition, Graduate School of Human Life & Ecology, Osaka Metropolitan University, Habikino 583-8555, Osaka, Japan
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Cimoli M, Gibney J, Lim M, Castles J, Dammert P. Nil per os in the management of oropharyngeal dysphagia-exploring the unintended consequences. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1410023. [PMID: 38957683 PMCID: PMC11217566 DOI: 10.3389/fresc.2024.1410023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 07/04/2024]
Abstract
Nil per os (NPO), also referred to as Nil by Mouth (NBM), is a health-related intervention of withholding food and fluids. When implemented in the context of a person with dysphagia, NPO aims to mitigate risks of aspiration. However, evidence demonstrating that NPO is beneficial as an intervention for people with dysphagia is lacking. This paper explores the theoretical and empirical evidence relating to the potential benefits and adverse effects of NPO and asserts that NPO is not a benign intervention. This paper argues for applying an ethics framework when making decisions relating to the use of NPO as an intervention for dysphagia, in particular addressing informed consent and a person's right to self-determination.
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Affiliation(s)
- Michelle Cimoli
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Jennifer Gibney
- Speech Pathology Department, Nepean Hospital, Penrith, NSW, Australia
| | - Mathew Lim
- Dental Services, Alfred Health, Prahran, VIC, Australia
- Melbourne Dental School, University of Melbourne, Carlton, VIC, Australia
| | - Jo Castles
- Speech PathologyDepartment, Allied Health Division, Austin Health, Heidelberg, VIC, Australia
| | - Pedro Dammert
- Pulmonary and Critical Care Department, Scripps Mercy Hospital Chula Vista, Chula Vista, CA, United States
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Ashford JR. Impaired oral health: a required companion of bacterial aspiration pneumonia. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1337920. [PMID: 38894716 PMCID: PMC11183832 DOI: 10.3389/fresc.2024.1337920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/20/2024] [Indexed: 06/21/2024]
Abstract
Laryngotracheal aspiration has a widely-held reputation as a primary cause of lower respiratory infections, such as pneumonia, and is a major concern of care providers of the seriously ill orelderly frail patient. Laryngeal mechanical inefficiency resulting in aspiration into the lower respiratory tract, by itself, is not the cause of pneumonia. It is but one of several factors that must be present simultaneously for pneumonia to develop. Aspiration of oral and gastric contentsoccurs often in healthy people of all ages and without significant pulmonary consequences. Inthe seriously ill or elderly frail patient, higher concentrations of pathogens in the contents of theaspirate are the primary catalyst for pulmonary infection development if in an immunocompromised lower respiratory system. The oral cavity is a complex and ever changing eco-environment striving to maintain homogeneity among the numerous microbial communities inhabiting its surfaces. Poor maintenance of these surfaces to prevent infection can result inpathogenic changes to these microbial communities and, with subsequent proliferation, can altermicrobial communities in the tracheal and bronchial passages. Higher bacterial pathogen concentrations mixing with oral secretions, or with foods, when aspirated into an immunecompromised lower respiratory complex, may result in bacterial aspiration pneumonia development, or other respiratory or systemic diseases. A large volume of clinical evidence makes it clear that oral cleaning regimens, when used in caring for ill or frail patients in hospitals and long-term care facilities, drastically reduce the incidence of respiratory infection and death. The purpose of this narrative review is to examine oral health as a required causative companionin bacterial aspiration pneumonia development, and the effectiveness of oral infection control inthe prevention of this disease.
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Lim TW, Li KY, Burrow MF, McGrath C. Prevalence of respiratory pathogens colonizing on removable dental prostheses in healthy older adults: A systematic review and meta-analysis. J Prosthodont 2024; 33:417-426. [PMID: 37970708 DOI: 10.1111/jopr.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/07/2023] [Accepted: 11/09/2023] [Indexed: 11/17/2023] Open
Abstract
PURPOSE This systematic review and meta-analysis aimed to investigate the prevalence of opportunistic respiratory pathogens colonizing removable dental prostheses in older adults without respiratory diseases. METHODS This review was registered with PROSPERO and conducted in accordance with the principles formed by the working group of the Joanna Briggs Institute (JBI) to evaluate systematic reviews of prevalence data. Literature searches were conducted across five electronic databases. Quality assessments were determined according to a revised JBI critical appraisal checklist across nine criteria. Comparison between fixed- and random-effects meta-analyses were performed for sensitivity analysis. Prediction intervals were also presented when three or more studies were included in the meta-analysis. RESULTS Across the databases, 1091 articles were identified, and 591 articles remained after the removal of duplicates. Twenty "potentially effective" studies were identified. Ultimately eight studies informed this review and meta-analyses were performed for 13 known respiratory pathogens. The meta-analyses identified the top three common respiratory pathogens residing on the removable prostheses were, in descending order: Staphylococcus aureus: 31.81% (95% CI: 13.34%-48.24%); Staphylococcus epidermidis: 14.07% (95% CI: 7.88%-21.48%); Klebsiella pneumoniae: 10.50% (95% CI: 2.55%-22.30%). The heterogeneity scores for nine respiratory pathogen analyses were classified as "unimportant inconsistency", I2 = 0% (p > 0.1). For sensitivity analysis, there was no difference between the random- and fixed-effects models. CONCLUSION The existing evidence demonstrated a high burden of certain opportunistic respiratory pathogens, which may be considered a major potential cause of respiratory infections in older adults wearing removable prostheses.
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Affiliation(s)
- Tong Wah Lim
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Kar Yan Li
- Dental Public Health, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Michael Francis Burrow
- Division of Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
| | - Colman McGrath
- Division of Applied Oral Sciences and Community Dental Care, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
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Tomonaga I, Koseki H, Imai C, Shida T, Nishiyama Y, Yoshida D, Yokoo S, Osaki M. Incidence and characteristics of aspiration pneumonia in the Nagasaki Prefecture from 2005 to 2019. BMC Pulm Med 2024; 24:191. [PMID: 38643064 PMCID: PMC11032591 DOI: 10.1186/s12890-024-03015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Aspiration pneumoniae remains a major health concern, particularly in the older population and has poor prognosis; however, the concept itself remains vague worldwide. This study aimed to determine the actual situation and characteristics of aspiration pneumonia from 2005 to 2019 in Nagasaki Prefecture, Japan. METHODS Cases of aspiration pneumonia that occurred in the Nagasaki Prefecture between 2005 and 2019 were analyzed using emergency transportation records. The number of occurrences and incidence were analyzed according to age, sex, month, day of the week, and recognition time to clarify the actual situation of aspiration pneumonia. RESULTS The total number of new aspiration pneumonia cases was 8,321, and the mean age of the patients was 83.0 years. Annual incidence per 100,000 population increased from 12.4 in 2005 to 65.1 in 2019, with the most prominent increase in the ≥ 80-year-old stratum. Males (55.1%) were more commonly affected than females (44.9%), and 82.2% of the cases involved patients aged ≥ 70 years. No significant correlations were observed between the incidence of aspiration pneumonia and season, month, or day of the week. Aspiration pneumonia occurred frequently in houses (39.8%) and facilities for elderly individuals (40.8%). At 7 days after admission, 80.9% of patients were still hospitalized and 6.5% had died. CONCLUSIONS The incidence of aspiration pneumonia with risks of severity and mortality is increasing among elderly individuals. Valid preventive measures are urgently needed based on the findings that the disease occurs in both household and elderly care facility settings, regardless of the season.
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Affiliation(s)
- Iku Tomonaga
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hironobu Koseki
- Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan.
| | - Chieko Imai
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takayuki Shida
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Yuta Nishiyama
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Daisuke Yoshida
- Department of Physical Therapy Science, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8520, Japan
| | - Seiichi Yokoo
- Department of Nursing, Fukuoka International University of Health and Welfare, 1-7-4 Momochihama, Sawara, Fukuoka, 814-0001, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
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Pan D, Chung S, Nielsen E, Niederman MS. Aspiration Pneumonia. Semin Respir Crit Care Med 2024; 45:237-245. [PMID: 38211629 DOI: 10.1055/s-0043-1777772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting that dysbiosis, repetitive injury, and inflammatory responses play a role in its development. Risk factors for aspiration events involve a complex interplay of anatomical and physiological dysfunctions in the nervous, gastrointestinal, and pulmonary systems. Current treatment strategies have shifted away from anaerobic organisms as leading pathogens. Prevention of aspiration pneumonia primarily involves addressing oropharyngeal dysphagia, a significant risk factor for aspiration pneumonia, particularly among elderly individuals and those with cognitive and neurodegenerative disorders.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Samuel Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Erik Nielsen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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Santos Zambrano TB, Guillén Vivas XS, Santos CB, de Fátima Mestre V, Maddela NR, Galarza Santana LE, Couto de Almeida RS. Evaluation of brushing efficiency in reducing oral microbiota in mechanically ventilated patients admitted to an intensive care unit. Infect Prev Pract 2024; 6:100346. [PMID: 38380354 PMCID: PMC10877438 DOI: 10.1016/j.infpip.2024.100346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024] Open
Abstract
Background Patients admitted to the Intensive Care Unit (ICU) are at greater risk of developing nosocomial infections due to their investigations, treatment and changes in the immune system. One of the most prevalent nosocomial infections is respiratory tract infection, such as hospital acquired pneumonia and ventilator-associated pneumonia (VAP). The bacteria commonly found in the oral cavity in the hospital environment are Streptococcus viridians, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., and Klebsiella pneumoniae. There is a need to test and define appropriate standard protocols for oral hygiene in patients undergoing mechanical ventilation in ICUs through the intervention of a dental specialist, preventing the proliferation of microorganisms into the respiratory tract, thus reducing hospitalization time, the use of antibiotics, and increased morbidity/mortality. Objective: This study aimed to evaluate the effectiveness of dental brushing in the reduction of the pathogenic buccal microbiota associated with mechanical ventilation in patients admitted to the Evangelical Hospital from Londrina, Paraná, Brazil. Methodology The sample consisted of 90 patients (of both sexes), mean age of 65 years, under mechanical ventilation by orotracheal tube and tracheostomized patients, without suspected or confirmed diagnosis of pneumonia. Patients were randomized ∗∗∗. Results Results showed that oral hygiene using a toothbrush by suction, with chlorhexidine gel 0.12% (Group B), was more effective than conventional hygiene using gauze soaked with chlorhexidine 0.12% (Group A) in reducing pathogenic buccal microbiota. Conclusions There was a reduction of the pathogenic buccal microbiota in mechanically ventilated patients receiving oral hygiene using a toothbrush by suction with chlorhexidine gel 0.12% (Group B).
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Affiliation(s)
| | | | | | | | - Naga Raju Maddela
- Departamento de Ciencias Biológicas, Facultad de Ciencias de la Salud, Universidad Técnica de Manabí, Portoviejo, Ecuador
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Baharvand R, Fallah F, Jafari P, Azimi L. Co-colonization of methicillin-resistant Staphylococcus aureus and Candida spp. in children with malignancies. AMB Express 2024; 14:22. [PMID: 38351284 PMCID: PMC10864235 DOI: 10.1186/s13568-024-01667-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
This study aimed to evaluate the interaction between methicillin-resistant Staphylococcus aureus(MRSA) and Candida spp. in the oral cavity of children with malignancies under chemotherapy. We evaluated the expression level of Als3p and mecA in Candida spp. and MRSA strains in both single colonization and co-colonization condition. Oral and nasal samples were collected by dry sponge swabs in 10 ml of sterile phosphate-buffered saline. The MRSA and Candida spp. was confirmed using the PCR method and mecA and Als3p genes, respectively. The SYBR Green-based quantitative real-time PCR was used to evaluate the relative expression levels of mecA and Als3p genes in MRSA and Candida spp., respectively. The frequency of S. aureus in oral-only and nasal-only swab samples were 14.1% (n = 24/170). 58.3% (n = 14/24) and 29.2% (n = 7/24) of S. aureus isolated from oral and nasal samples were MRSA, respectively. Among Candida species, C. albicans (n = 28/170; 16.5%) had the highest frequency. The oral co-colonization of MRSA and Candida spp. was detected in 4.7% (n = 8/170) patients. The overall average of gene expression levels among all Candida spp. and MRSA isolates indicated that the mecA and Als3p genes expression increased six and two times in co-colonization conditions compared to single colonization conditions, respectively. Our findings revealed the importance of polymicrobial infection in clinical settings and stated that it is possible that Candida spp. facilitates the infection of S. aureus and can lead to systemic infection in co-colonized patients.
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Affiliation(s)
- Raziyeh Baharvand
- Department of Microbiology, Faculty of Science, Islamic Azad University, Arak branch, Arak, Iran
| | - Fatemeh Fallah
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Jafari
- Department of Microbiology, Faculty of Science, Islamic Azad University, Arak branch, Arak, Iran.
| | - Leila Azimi
- Pediatric Infections Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Park YS, Yun I, Jang SY, Park EC, Jang SI. Association between nurse staffing level in intensive care settings and hospital-acquired pneumonia among surgery patients: result from the Korea National Health Insurance cohort. Epidemiol Infect 2024; 152:e62. [PMID: 38326273 PMCID: PMC11062778 DOI: 10.1017/s0950268824000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
This study examined the association between the number of nursing staff in intensive care units (ICUs) and hospital-acquired pneumonia (HAP) among surgical patients in South Korea. Data were obtained between 2008 and 2019 from the Korean National Health Insurance Service Cohort Database; 37,706 surgical patients who received critical care services were included in the analysis. Patients with a history of pneumonia 1 year prior to surgery or those who had undergone lung-related surgery were excluded. The ICU nursing management fee is an admission fee that varies based on the grading determined by nurse-to-bed ratio. Using this grading system, we classified four groups from the highest to the lowest level based on the proportion of beds to nurses (high, high-mid, mid-low, and low group). HAP was defined by the International Classification of Disease, 10th revision (ICD-10) code. Multilevel logistic regression was used to investigate the relationship between the level of ICU nurse staffing and pneumonia, controlling for variables at the individual and hospital levels. Lower levels of nurse staffing were associated with a greater incidence of HAP than higher levels of nurse staffing (mid-high, OR: 1.33, 95% CI: 1.12-1.57; mid-low, OR: 1.61, 95% CI: 1.27-2.04; low, OR: 2.13, 95% CI: 1.67-2.71). The intraclass correlation coefficient value was 0.177, and 17.7% of the variability in HAP was accounted for by the hospital. Higher ICU nursing management fee grades (grade 5 and above) in general and hospital settings were significantly associated with an increased risk of HAP compared to grade 1 admissions. Similarly, in tertiary hospitals, grade 2 and higher ICU nursing management fees were significantly associated with an increased risk of HAP compared to grade 1 admissions. Especially, a lower level of nurse staffing was associated with bacterial pneumonia but not pneumonia due to aspiration. In conclusion, this study found an association between the level of ICU nurse staffing and HAP among surgical patients. A lower level of nurse staffing in the ICU was associated with increased rates of HAP among surgical patients. This indicates that having fewer beds assigned to nurses in the ICU setting is a significant factor in preventing HAP, regardless of the size of the hospital.
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Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Il Yun
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Ball L, Meteyard L, Powell RJ. Predictors of aspiration pneumonia: developing a new matrix for speech and language therapists. Eur Arch Otorhinolaryngol 2023; 280:5101-5114. [PMID: 37543958 DOI: 10.1007/s00405-023-08153-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION The contributing factors of aspiration pneumonia have been well documented. However, there are gaps in the literature regarding identifying the weight associated with each factor and the relationship between factors. METHOD In this study, 20 potential predictors of aspiration pneumonia (with four additional variables) have been applied to historic Speech and Language Therapy records to greater understand the significance of each contributor of aspiration pneumonia. 152 cases with an oropharyngeal dysphagia, and a Speech and Language Therapy recommendation of eating and drinking with known aspiration and the associated potential risk of developing an aspiration pneumonia, were included in the data. These were inpatients and outpatients, and had various diagnoses but all had had a videofluoroscopy. RESULTS Logistic regression analysis found seven factors that were individually significant in predicting the development of aspiration pneumonia with 84.93% sensitivity and 91.03% specificity DISCUSSION: Logistic regression and random forest analyses led to the proposal of a new matrix of predictors of aspiration pneumonia with respective scoring weights for individual and cumulative contributors (a direction for future research).
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Affiliation(s)
- Laura Ball
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
| | - Lotte Meteyard
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Roy J Powell
- NIHR Research Design Service-SW, Exeter, UK
- University of Exeter Medical School, Exeter, UK
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14
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Bogner MS, Chambas V, Nicolas E, Faulks D, Hennequin M. Implant-supported prostheses in patients with special needs: A systematic literature review of protocols and outcomes. J Prosthet Dent 2023:S0022-3913(23)00628-5. [PMID: 37880026 DOI: 10.1016/j.prosdent.2023.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023]
Abstract
STATEMENT OF PROBLEM Implant-supported prostheses for individuals with special needs have been considered high-risk because of the prevalence of poor oral hygiene and parafunction in this population; however, systematic evidence on protocols and outcomes is scarce. PURPOSE The purpose of this systematic review was to summarize implant procedures and outcomes for the special needs population. MATERIAL AND METHODS A systematic literature review was conducted using PubMed, Embase, and Scopus databases in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodological framework. Data collected included patient information, location and number of implants, surgical and prosthetic procedures, behavior support techniques, postoperative follow-up, complications, and criteria for outcome assessment. Survival rates were pooled for quantitative analysis, and a separate analysis pooling data from groups of special needs patients that present similar risks was undertaken. RESULTS The qualitative analysis included 79 studies involving 759 patients and 2269 implants. The quantitative analysis included 65 studies concerning 666 patients with special needs and 1886 implants. The overall weighted implant survival rate was 95.4%, with a mean follow-up duration of 40.7 ±29.5 months. CONCLUSIONS In individuals with special needs considered suitable for implant-supported prostheses by their clinician, implant survival rates were similar to those reported in the general population. (J Prosthet Dent xxxx;xxx:xxx-xxx).
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Affiliation(s)
- Marie-Sophie Bogner
- Specialist, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France.
| | - Vivien Chambas
- Specialist, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France; and Private practice, Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Professor, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France; and CHU Clermont-Ferrand, Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
| | - Denise Faulks
- Specialist Consultant, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, F-63000 Clermont-Ferrand, France; and CHU Clermont-Ferrand, Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
| | - Martine Hennequin
- Professor, Centre for Research in Clinical Dentistry (CROC), University of Clermont Auvergne BP 10448, Clermont-Ferrand, France; and CHU Clermont-Ferrand, Service d'Odontologie, CHU Estaing, Clermont-Ferrand, France
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15
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Papalexopoulos D, Samartzi TK, Sykaras N, Artopoulou II. Chairside transformation of a removable partial denture to a transitional complete denture to alleviate an impaired stroke patient: A case report. SPECIAL CARE IN DENTISTRY 2023; 43:666-670. [PMID: 36266778 DOI: 10.1111/scd.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/13/2022] [Accepted: 10/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this clinical report is to present a technique for transformation of an existing removable partial denture (RPD) into a transitional complete denture (CD) for an impaired stroke patient. CASE PRESENTATION A 67-year-old male who underwent an ischemic stroke 12 months ago presented in the Postgraduate Clinic of the National and Kapodistrian University of Athens, requiring treatment of his remaining teeth and repair of his existing RPD which lacked retention and stability. The treatment plan included placement of amalgam plugs on the remaining teeth which were decoronated due to poor prognosis and modification of the existing RPD to a transitional CD. The procedure included one alginate impression and chairside alteration of the prosthesis with simple means. The new prosthesis managed to improve patient's masticatory ability and reduce the risk for aspiration pneumonia. CONCLUSION In the present case report a technique for modifying an existing RPD into a transitional CD for an impaired, stroke patient is described. Reduced treatment time, costs and patient's inconvenience while embracing the benefits provided by the utilization of an existing prosthesis regarding adaptation of the neuromuscular system are among the advantages of the described technique.
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Affiliation(s)
| | | | - Nikitas Sykaras
- Department of Prosthodontics, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioli Ioanna Artopoulou
- Department of Prosthodontics, National and Kapodistrian University of Athens, Athens, Greece
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16
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Leira Y, Cho H, Marletta D, Orlandi M, Diz P, Kumar N, D'Aiuto F. Complications and treatment errors in periodontal therapy in medically compromised patients. Periodontol 2000 2023; 92:197-219. [PMID: 36166645 DOI: 10.1111/prd.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/28/2022]
Abstract
Patients who are medically compromised may be at an increased risk of complications and treatment errors following periodontal therapy. A review of the evidence on the topic is presented, in relation to the type of complication reported, of periodontal treatment, and of patients' medical status. Further, a framework for risk assessment and appropriate treatment modifications is introduced, with the aim of facilitating the management of patients with existing comorbidities and reducing the incidence of treatment complications.
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Affiliation(s)
- Yago Leira
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
- Periodontology Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Hana Cho
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | | | - Marco Orlandi
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
| | - Pedro Diz
- Special Care Dentistry Unit, Faculty of Odontology, University of Santiago de Compostela & Medical-Surgical Dentistry Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Navdeep Kumar
- Special Care Dentistry Unit, ENT & Eastman Dental Hospital, UCLH NHS Foundation Trust, London, UK
| | - Francesco D'Aiuto
- Periodontology Unit, UCL Eastman Dental Institute & NIHR UCLH Biomedical Research Centre, University College London, London, UK
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17
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Scannapieco FA. Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia. Clin Geriatr Med 2023; 39:257-271. [PMID: 37045532 DOI: 10.1016/j.cger.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Aspiration pneumonia (AP), inflammation of the lung parenchyma initiated by aspirated microorganisms into the lower airways from proximal sites, including the oral cavity, is prevalent in, and problematic for, the elderly, especially those in institutions, and for those with several important risk factors. Many factors influence the pathogenesis of AP, including dysphagia, poor oral hygiene, diminished host defense, and underlying medical conditions. This article reviews the epidemiology, microbiology, pathogenesis, and prevention of AP, focusing on the role of poor oral health as a risk factor for, and on dental care for the prevention and management of, this important infection.
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Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, Foster Hall, 3435 Main Street, Buffalo, NY 14214, USA.
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18
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Mitsutake S, Ishizaki T, Edahiro A, Kitamura A, Hirata T, Saito A. The effects of dental visits on the occurrence of acute hospitalization for systemic diseases among patients aged 75 years or older: A propensity score-matched study. Arch Gerontol Geriatr 2023; 107:104876. [PMID: 36516734 DOI: 10.1016/j.archger.2022.104876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Although several studies examined the association between oral status and the risk of systemic diseases, few have examined whether dental visits affect the occurrence of acute hospitalization due to systemic diseases. This study examined the effects of dental visits on preventing the occurrence of acute hospitalization due to systemic diseases in adults aged ≥ 75 years, in order to optimize the healthcare system for older adults. METHODS This propensity-score-matched retrospective cohort study was conducted using medical insurance claims data from Hokkaido, Japan. We analyzed 432,292 adult outpatients aged ≥ 75 years between September 2016 and February 2017 (baseline period). The exposure variable was visits to the dental office during the baseline period. The primary outcome variable was the occurrence of acute hospitalization due to pneumonia, urinary tract infections, cerebrovascular diseases, or coronary heart diseases between March 2017 and March 2019. RESULTS Among the 432,292 patients before propensity score matching, 149,639 (34.6%) had visited the dental office. One-to-one propensity score matching produced 149,289 matched pairs adjusted for the differences in all covariables (age, sex, copayment rate, annual health checkup, chronic diseases, and residential area). In these matched pairs, the risk ratio of the occurrence of acute hospitalization due to pneumonia, urinary tract infections, and cerebrovascular diseases was lower among patients who had visited dental office than among those who did not. CONCLUSIONS Dental visits appeared to be effective in preventing acute hospitalization due to systemic diseases, thus, dental care services would be an important component of healthcare for older adults.
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Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University, Nara, Japan
| | - Atsushi Saito
- Department of Peridontology, Tokyo Dental College, Tokyo, Japan
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19
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Saito M, Shimazaki Y, Yoshii S, Takeyama H. Periodontitis and the incidence of chronic obstructive pulmonary disease: A longitudinal study of an adult Japanese cohort. J Clin Periodontol 2023; 50:717-726. [PMID: 36864721 DOI: 10.1111/jcpe.13801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 03/04/2023]
Abstract
AIM To examine the relationship between periodontitis as an independent effect of smoking and the development of chronic obstructive pulmonary disease (COPD) in Japanese people based on longitudinal data. MATERIALS AND METHODS We targeted 4745 people who underwent pulmonary function tests and dental check-ups at baseline and 8 years later. The Community Periodontal Index was used to assess periodontal status. A Cox proportional hazard model was used to examine the relationship between the incidence of COPD and periodontitis and smoking. To clarify the interaction between smoking and periodontitis, interaction analysis was performed. RESULTS In a multivariable analysis, both periodontitis and heavy smoking had significant effects on COPD development. When periodontitis was analysed as a continuous value (number of sextants with periodontitis) and as a category (presence or absence of periodontitis) in the multivariable analyses after adjusting for smoking, pulmonary function and other variables, periodontitis had significantly higher hazard ratios (HRs) for the incidence of COPD; the HRs were 1.09 (1.01-1.17) and 1.48 (1.09-2.02), respectively. Interaction analysis showed no significant interaction between heavy smoking and periodontitis on COPD. CONCLUSIONS These results suggest that periodontitis has no interaction with smoking but has an independent effect on developing COPD.
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Affiliation(s)
- Mizuki Saito
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Yoshihiro Shimazaki
- Department of Preventive Dentistry and Dental Public Health, School of Dentistry, Aichi Gakuin University, Nagoya, Japan
| | - Saori Yoshii
- Aichi Health Promotion Foundation, Nagoya, Japan
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20
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Chu K, Zhang Z, Chu Y, Xu Y, Yang W, Guo L. Ginsenoside Rg1 alleviates lipopolysaccharide-induced pyroptosis in human periodontal ligament cells via inhibiting Drp1-mediated mitochondrial fission. Arch Oral Biol 2023; 147:105632. [PMID: 36736069 DOI: 10.1016/j.archoralbio.2023.105632] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/29/2022] [Accepted: 01/25/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The present study aimed to investigate whether Ginsenoside Rg1 alleviated lipopolysaccharide (LPS) - induced pyroptosis of human periodontal ligament cells (HPDLCs) and further explore the underlying mechanism. DESIGN Cell viability was detected using the CCK-8 assay. Proinflammatory cytokine secretion and lactate dehydrogenase release were examined by ELISA. Flow cytometry analysis was conducted to determine the pyroptosis ratio, and ATP production was estimated using the ATP assay kit. Fluorescence staining was utilized to visualize mitochondrial morphology and analyze mitochondrial reactive oxygen species (mtROS), and the mitochondrial membrane potential level. Western blot and qRT-PCR were used to determine the expression of signaling pathway-related proteins and mRNA, respectively. RESULTS The results discovered that Ginsenoside Rg1 treatment enhanced cell viability in comparison to LPS stimulation, attenuated pyroptosis in HPDLCs, and reduced the release of lactate dehydrogenase, IL-1β, and IL-18 significantly. Additionally, we found that Ginsenoside Rg1 upregulated ATP content and mitochondrial membrane potential level while reducing aberrant mitochondrial fission and mtROS production. Mechanistically, we found that Ginsenoside Rg1 upregulated dynamin-related protein 1 (Drp1) phosphorylation at Ser 637 in an AMP-activated protein kinase (AMPK)-dependent manner, and reduced pyroptosis-related proteins expression, including NLRP3, ASC, Caspase-1, and GSDMD-NT. CONCLUSIONS These findings demonstrate that Ginsenoside Rg1 treatment attenuates LPS-induced pyroptosis and inflammation damage in HPDLCs, which may connect to the activation of the AMPK/Drp1/NLRP3 signaling pathway. Moreover, the results offer a potential theoretical foundation for applying Ginsenoside Rg1 in inflammatory diseases such as periodontitis.
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Affiliation(s)
- Kefei Chu
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China; Department of Oral prosthodontics, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Zhenghao Zhang
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China; Department of Oral prosthodontics, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Yi Chu
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China; Department of Oral prosthodontics, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Yao Xu
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China; Department of Oral prosthodontics, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Wanrong Yang
- Luzhou Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China; Department of Oral prosthodontics, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China
| | - Ling Guo
- Department of Oral prosthodontics, The Affiliated Stomatological Hospital of Southwest Medical University, Luzhou 646000, Sichuan, PR China.
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Brucki SMD, Aprahamian I, Borelli WV, Silveira VCD, Ferretti CEDL, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Nitrini R, Schultz RR, Morillo LS. Management in severe dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s107en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Alzheimer’s disease (AD) and other neurodegenerative dementias have a progressive course, impairing cognition, functional capacity, and behavior. Most studies have focused on AD. Severe dementia is associated with increased age, higher morbidity-mortality, and rising costs of care. It is fundamental to recognize that severe dementia is the longest period of progression, with patients living for many years in this stage. It is the most heterogeneous phase in the process, with different abilities and life expectancies. This practice guideline focuses on severe dementia to improve management and care in this stage of dementia. As it is a long period in the continuum of dementia, clinical practice should consider non-pharmacological and pharmacological approaches. Multidisciplinary interventions (physical therapy, speech therapy, nutrition, nursing, and others) are essential, besides educational and support to caregivers.
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Affiliation(s)
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Brasil; University of Groningen, The Netherlands; Universidade de São Paulo, Brasil
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brazil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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22
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Brucki SMD, Aprahamian I, Borelli WV, Silveira VCD, Ferretti CEDL, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Nitrini R, Schultz RR, Morillo LS. Manejo das demências em fase avançada: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:101-120. [DOI: 10.1590/1980-5764-dn-2022-s107pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/04/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022] Open
Abstract
RESUMO A doença de Alzheimer (DA) e outras demências neurodegenerativas têm um curso progressivo com comprometimento da cognição, capacidade funcional e comportamento. A maioria dos estudos enfocou a DA. A demência grave está associada ao aumento da idade, maior morbimortalidade e aumento dos custos de cuidados. É fundamental reconhecer que a demência grave é o período mais longo de progressão, com o paciente vivendo muitos anos nesta fase. É a fase mais heterogênea do processo, com diferentes habilidades e expectativa de vida. Esta diretriz de prática concentra-se na demência grave para melhorar o manejo e o cuidado nessa fase da demência. Como um longo período no continuum da demência, as abordagens não farmacológicas e farmacológicas devem ser consideradas. Intervenções multidisciplinares (fisioterapia, fonoaudiologia, nutrição, enfermagem, entre outras) são essenciais, além de educacionais e de apoio aos cuidadores.
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Affiliation(s)
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Brasil; University of Groningen, The Netherlands; Universidade de São Paulo, Brasil
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brazil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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23
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Jungbauer G, Stähli A, Zhu X, Auber Alberi L, Sculean A, Eick S. Periodontal microorganisms and Alzheimer disease - A causative relationship? Periodontol 2000 2022; 89:59-82. [PMID: 35244967 PMCID: PMC9314828 DOI: 10.1111/prd.12429] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/07/2021] [Accepted: 12/21/2021] [Indexed: 01/10/2023]
Abstract
In the initiation or exacerbation of Alzheimer disease, the dissemination of oral microorganisms into the brain tissue or the low‐level systemic inflammation have been speculated to play a role. However, the impact of oral microorganisms, such as Porphyromonas gingivalis, on the pathogenesis of Alzheimer disease and the potential causative relationship is still unclear. The present review has critically reviewed the literature by examining the following aspects: (a) the oral microbiome and the immune response in the elderly population, (b) human studies on the association between periodontal and gut microorganisms and Alzheimer disease, (c) animal and in vitro studies on microorganisms and Alzheimer disease, and (d) preventive and therapeutic approaches. Factors contributing to microbial dysbiosis seem to be aging, local inflammation, systemic diseases, wearing of dentures, living in nursing homes and no access to adequate oral hygiene measures. Porphyromonas gingivalis was detectable in post‐mortem brain samples. Microbiome analyses of saliva samples or oral biofilms showed a decreased microbial diversity and a different composition in Alzheimer disease compared to cognitively healthy subjects. Many in‐vitro and animal studies underline the potential of P gingivalis to induce Alzheimer disease‐related alterations. In animal models, recurring applications of P gingivalis or its components increased pro‐inflammatory mediators and β‐amyloid in the brain and deteriorated the animals' cognitive performance. Since periodontitis is the result of a disturbed microbial homoeostasis, an effect of periodontal therapy on the oral microbiome and host response related to cognitive parameters may be suggested and should be elucidated in further clinical trials.
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Affiliation(s)
- Gert Jungbauer
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Private Dental Practice, Straubing, Germany
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Xilei Zhu
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Sigrun Eick
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Pulmonary disease and periodontal health: a meta-analysis. Sleep Breath 2022; 26:1857-1868. [PMID: 35122603 DOI: 10.1007/s11325-022-02577-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Research has shown a positive relationship between pulmonary and periodontal disease. However, the relationship remains unclear. The aim of this meta-analysis was to evaluate the associations between pulmonary disease and periodontal health. MATERIALS AND METHODS MEDLINE, PubMed, EMBASE, Web of Science, Science Citation Index, Wanfang, and CNKI were searched for all the relevant studies of relationship between pulmonary disease and periodontal health. Weighted mean difference (WMD)/odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of the association. RESULTS Thirty-seven studies were included in this meta-analysis. Pooled analysis showed a significant association between pulmonary and periodontal disease (adjusted OR, 1.93; 95%CI: 1.60-2.33; P < 0.05), and pooled adjusted OR was 1.64, 3.03, and 2.21 in COPD, asthma, and pneumonia, respectively. The pooled analysis also showed that patients with pulmonary disease suffered from worse periodontal health as most periodontal indexes in those patients were poorer. CONCLUSIONS There is a strong association between pulmonary disease and periodontal health. Clinical trials analyzing the causality and pathological basis of the association of these two diseases are needed.
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25
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Shinohara M, Maetani M, Kitada C, Nishigami Y, Yazawa A, Kamitani S. Analysis of the Effects of Food Additives on Porphyromonas gingivalis. Pathogens 2022; 11:pathogens11010065. [PMID: 35056013 PMCID: PMC8779409 DOI: 10.3390/pathogens11010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/31/2021] [Accepted: 12/31/2021] [Indexed: 12/04/2022] Open
Abstract
This study aims to investigate six food additives (octanoic acid, decanoic acid, acesulfame K, aspartame, saccharin, and sucralose) used in foods for the elderly or people with dysphagia because of the effect of these food additives on Porphyromonas gingivalis (P. gingivalis), which is a keystone pathogen of periodontal diseases. The growth of P. gingivalis was inhibited by 5 mM octanoic acid, 1.25 mM decanoic acid, 1.25% acesulfame K, 0.0625% aspartame, 0.03125% saccharin, and 0.625% sucralose. In addition, these food additives showed bactericidal activity for planktonic P. gingivalis (5 mM octanoic acid, 5 mM decanoic acid, 0.25% aspartame, 0.25% saccharin, and 5% sucralose). Moreover, biofilm formation was inhibited by 10 mM octanoic acid, 10 mM decanoic acid, 10% acesulfame K, 0.35% aspartame, 0.5% saccharin, and 7.5% sucralose. Moreover, the same concentration of these food additives without aspartame killed P. gingivalis in the biofilm. Aspartame and sucralose did not show cytotoxicity to human cell lines at concentrations that affected P. gingivalis. These findings may be useful in clarifying the effects of food additives on periodontopathogenic bacteria.
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26
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Rodriguez-Hernandez CJ, Sokoloski KJ, Stocke KS, Dukka H, Jin S, Metzler MA, Zaitsev K, Shpak B, Shen D, Miller DP, Artyomov MN, Lamont RJ, Bagaitkar J. Microbiome-mediated incapacitation of interferon lambda production in the oral mucosa. Proc Natl Acad Sci U S A 2021; 118:e2105170118. [PMID: 34921113 PMCID: PMC8713781 DOI: 10.1073/pnas.2105170118] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/03/2021] [Indexed: 09/29/2023] Open
Abstract
Here, we show that Porphyromonas gingivalis (Pg), an endogenous oral pathogen, dampens all aspects of interferon (IFN) signaling in a manner that is strikingly similar to IFN suppression employed by multiple viral pathogens. Pg suppressed IFN production by down-regulating several IFN regulatory factors (IRFs 1, 3, 7, and 9), proteolytically degrading STAT1 and suppressing the nuclear translocation of the ISGF3 complex, resulting in profound and systemic repression of multiple interferon-stimulated genes. Pg-induced IFN paralysis was not limited to murine models but was also observed in the oral tissues of human periodontal disease patients, where overabundance of Pg correlated with suppressed IFN generation. Mechanistically, multiple virulence factors and secreted proteases produced by Pg transcriptionally suppressed IFN promoters and also cleaved IFN receptors, making cells refractory to exogenous IFN and inducing a state of broad IFN paralysis. Thus, our data show a bacterial pathogen with equivalence to viruses in the down-regulation of host IFN signaling.
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Affiliation(s)
- Carlos J Rodriguez-Hernandez
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY 40202
| | - Kevin J Sokoloski
- Department of Microbiology and Immunology, University of Louisville, Louisville, KY 40202
| | - Kendall S Stocke
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202
| | - Himabindu Dukka
- Department of Diagnosis and Oral Health, University of Louisville, Louisville, KY 40202
| | - Shunying Jin
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202
| | - Melissa A Metzler
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202
| | - Konstantin Zaitsev
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110
| | - Boris Shpak
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110
| | - Daonan Shen
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202
| | - Daniel P Miller
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202
| | - Maxim N Artyomov
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110
| | - Richard J Lamont
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202;
| | - Juhi Bagaitkar
- Department of Oral Immunology and Infectious Diseases, School of Dentistry, University of Louisville, Louisville, KY 40202;
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27
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Grossmann I, Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, Zamora DI, Patel GS, Sange I. Stroke and Pneumonia: Mechanisms, Risk Factors, Management, and Prevention. Cureus 2021; 13:e19912. [PMID: 34984111 PMCID: PMC8713735 DOI: 10.7759/cureus.19912] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 12/28/2022] Open
Abstract
A stroke is a cerebrovascular medical emergency characterized by the sudden loss of neurological function due to interruption to the blood supply. A serious and common complication of stroke is pneumonia. This review article outlined various studies in order to understand the pathogenesis pathways that lead to the development of stroke-associated pneumonia, as well as therapeutic and preventive options to reduce pneumonia. The article looked for risk factors that increase the risk of developing pneumonia among stroke patients. In addition, it has reviewed various therapeutic modalities, such as postural modifications, pharmacological treatment, and other unique treatments, in an attempt to find which of them are efficient to decrease the occurrence of pneumonia and which of them are not. The article also attempts to emphasize the importance of early screening for dysphagia among stroke patients and demonstrates the importance of preventive strategies that can be easily implemented, such as routine oral care and behavioral modifications.
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Affiliation(s)
- Idan Grossmann
- Research, Medical University of Silesia Faculty of Medical Sciences, Katowice, POL
| | - Kevin Rodriguez
- Research, Universidad Americana (UAM) Facultad de Medicina, Managua, NIC
| | - Mridul Soni
- Research, Shri Lal Bahadur Shastri Government Medical College, Mandi, IND
| | - Pranay K Joshi
- Medicine, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | | | | | - Diana I Zamora
- General Medicine, Universidad de Ciencias Médicas Andrés Vesalio Guzman, San José, CRI
| | - Gautami S Patel
- Internal Medicine, Pramukhswami Medical College, Karamsad, IND
| | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Research, KJ Somaiya Medical College, Mumbai, IND
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28
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Bao L, Zhang C, Lyu J, Yan C, Cao R, Pan M, Li Y. Beware of pharyngeal Fusobacterium nucleatum in COVID-19. BMC Microbiol 2021; 21:277. [PMID: 34635053 PMCID: PMC8504566 DOI: 10.1186/s12866-021-02336-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/01/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Fusobacterium nucleatum (F. n) is an important opportunistic pathogen causing oral and gastrointestinal disease. Faecalibacterium prausnitzii (F. p) is a next-generation probiotic and could serve as a biomarker of gut eubiosis/dysbiosis to some extent. Alterations in the human oral and gut microbiomes are associated with viral respiratory infection. The aim of this study was to characterise the oral and fecal bacterial biomarker (i.e., F. n and F. p) in COVID-19 patients by qPCR and investigate the pharyngeal microbiome of COVID-19 patients through metagenomic next-generation sequencing (mNGS). RESULTS Pharyngeal F. n was significantly increased in COVID-19 patients, and it was higher in male than female patients. Increased abundance of pharyngeal F. n was associated with a higher risk of a positive SARS-CoV-2 test (adjusted OR = 1.32, 95% CI = 1.06 ~ 1.65, P < 0.05). A classifier to distinguish COVID-19 patients from the healthy controls based on the pharyngeal F. n was constructed and achieved an area under the curve (AUC) of 0.843 (95% CI = 0.688 ~ 0.940, P < 0.001). However, the level of fecal F. n and fecal F. p remained unaltered between groups. Besides, mNGS showed that the pharyngeal swabs of COVID-19 patients were dominated by opportunistic pathogens. CONCLUSIONS Pharyngeal but not fecal F. n was significantly increased in COVID-19 patients, clinicians should pay careful attention to potential coinfection. Pharyngeal F. n may serve as a promising candidate indicator for COVID-19.
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Affiliation(s)
- Lirong Bao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Cheng Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Jinglu Lyu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Caixia Yan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China
| | - Ranran Cao
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, China.
| | - Ming Pan
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, China.
| | - Yan Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, 610041, China.
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29
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Gibney JM, Naganathan V, Lim MAWT. Oral health is Essential to the Well-Being of Older People. Am J Geriatr Psychiatry 2021; 29:1053-1057. [PMID: 34246517 DOI: 10.1016/j.jagp.2021.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 01/27/2023]
Abstract
Although the highest attainable standard of health is a fundamental human right, oral health is often not considered an important component of overall health. Older people experience poorer quality of life due to discomfort and uncleanliness of their mouth and there continue to be barriers within health systems that contribute to this poor oral health. This paper advocates for oral health to be considered part of the basic human right to good health care and discusses how stakeholders can collaborate and work together to begin to meet the needs of this population, proposing solutions and recommendations to bring about change.
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Affiliation(s)
- Jennifer Mary Gibney
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, New South Wales, Australia; Nepean Hospital, Sydney, New South Wales, Australia.
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, Sydney, New South Wales, Australia
| | - Mathew Albert Wei Ting Lim
- Dental Services, Alfred Health, Melbourne, Victoria, Australia; Maxillofacial and Dental Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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30
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Antibiotic Prescriptions Targeting Bacterial Respiratory Infections in Admitted Patients with COVID-19: A Prospective Observational Study. Infect Dis Ther 2021; 10:2575-2591. [PMID: 34529255 PMCID: PMC8444524 DOI: 10.1007/s40121-021-00535-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/03/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Although bacterial co- and superinfections are rarely present in patients with COVID-19, overall antibiotic prescribing in admitted patients is high. In order to counter antibiotic overprescribing, antibiotic stewardship teams need reliable data concerning antibiotic prescribing in admitted patients with COVID-19. Methods In this prospective observational cohort study, we performed a quantitative and qualitative evaluation of antibiotic prescriptions in patients admitted to the COVID-19 ward of a 721-bed Belgian university hospital between 1 May and 2 November 2020. Data on demographics, clinical and microbiological parameters and antibiotic consumption were collected. Defined daily doses (DDD) were calculated for antibiotics prescribed in the context of a (presumed) bacterial respiratory tract infection and converted into two indicators: DDD/admission and DDD/100 hospital bed days. A team of infectious disease specialists performed an appropriateness evaluation for every prescription. A driver analysis was performed to identify factors increasing the odds of an antibiotic prescription in patients with a confirmed COVID-19 diagnosis. Results Of 403 eligible participants with a suspected COVID-19 infection, 281 were included. In 13.8% of the 203 admissions with a COVID-19 confirmed diagnosis, antibiotics were initiated for a (presumed) bacterial respiratory tract co-/superinfection (0.86 DDD/admission; 8.92 DDD/100 bed days; 39.4% were scored as ‘appropriate’). Five drivers of antibiotic prescribing were identified: history of cerebrovascular disease, high neutrophil/lymphocyte ratio in male patients, age, elevated ferritin levels and the collection of respiratory samples for bacteriological analysis. Conclusion In the studied population, the antibiotic consumption for a (presumed) bacterial respiratory tract co-/superinfection was low. In particular, the small total number of DDDs in patients with confirmed COVID-19 diagnosis suggests thoughtful antibiotic use. However, antibiotic stewardship programmes remain crucial to counter unnecessary and inappropriate antibiotic use in hospitalized patients with COVID-19. Trial Registration The study is registered at ClinicalTrials.gov (NCT04544072). Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00535-2.
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31
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Curtis JS, Kennedy SE, Attarha B, Edwards L, Jacob R. Upper Gastrointestinal Disorders in Adult Patients with Intellectual and Developmental Disabilities. Cureus 2021; 13:e15384. [PMID: 34094790 PMCID: PMC8170855 DOI: 10.7759/cureus.15384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The purpose of this literature review is to address the diagnosis and treatment of upper gastrointestinal (GI) disorders in patients with intellectual and developmental disabilities (IDD). Manifestations of upper GI dysmotility and disorders include dysphagia, pulmonary aspiration, malnutrition, gastroesophageal reflux, and gastritis, all of which can impact a person’s quality of life and lead to chronic, life-threatening conditions. This article will explore the existing diagnostic methods and treatments for gastrointestinal disorders as they relate to patients with IDD.
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Affiliation(s)
- Jack S Curtis
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Sara E Kennedy
- Internal Medicine, University of Florida College of Medicine, Gainesville, USA
| | - Barrett Attarha
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Linda Edwards
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Rafik Jacob
- Internal Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Matsumoto K, Nohara Y, Wakata Y, Yamashita T, Kozuma Y, Sugeta R, Yamakawa M, Yamauchi F, Miyashita E, Takezaki T, Yamashiro S, Nishi T, Machida J, Soejima H, Kamouchi M, Nakashima N. Impact of a learning health system on acute care and medical complications after intracerebral hemorrhage. Learn Health Syst 2021; 5:e10223. [PMID: 33889732 PMCID: PMC8051343 DOI: 10.1002/lrh2.10223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/10/2020] [Accepted: 02/02/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Patients with stroke often experience pneumonia during the acute stage after stroke onset. Oral care may be effective in reducing the risk of stroke-associated pneumonia (SAP). We aimed to determine the changes in oral care, as well as the incidence of SAP, in patients with intracerebral hemorrhage, following implementation of a learning health system in our hospital. METHODS We retrospectively analyzed the data of 1716 patients with intracerebral hemorrhage who were hospitalized at a single stroke center in Japan between January 2012 and December 2018. Data were stratified on the basis of three periods of evolving oral care: period A, during which conventional, empirically driven oral care was provided (n = 725); period B, during which standardized oral care was introduced, with SAP prophylaxis based on known risk factors (n = 469); and period C, during which oral care was risk-appropriate based on learning health system data (n = 522). Logistic regression analysis was performed to evaluate associations between each of the three treatment approaches and the risk of SAP. RESULTS Among the included patients, the mean age was 71.3 ± 13.6 years; 52.6% of patients were men. During the course of each period, the frequency of oral care within 24 hours of admission increased (P < .001), as did the adherence rate to oral care ≥3 times per day (P < .001). After adjustment for confounding factors, a change in the risk of SAP was not observed in period B; however, the risk significantly decreased in period C (odds ratio 0.61; 95% confidence interval 0.43-0.87) compared with period A. These associations were maintained for SAP diagnosed using strict clinical criteria or after exclusion of 174 patients who underwent neurosurgical treatment. CONCLUSIONS Risk-appropriate care informed by the use of learning health system data could improve care and potentially reduce the risk of SAP in patients with intracerebral hemorrhage in the acute stage.
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Affiliation(s)
- Koutarou Matsumoto
- Department of Medical SupportSaiseikai Kumamoto HospitalKumamotoJapan
- Department of Health Care Administration and Management, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Yasunobu Nohara
- Medical Information CenterKyushu University HospitalFukuokaJapan
| | | | | | - Yukio Kozuma
- Department of Medical InformationSaiseikai Kumamoto HospitalKumamotoJapan
| | - Rui Sugeta
- Department of Medical InformationSaiseikai Kumamoto HospitalKumamotoJapan
| | - Miki Yamakawa
- Department of NursingSaiseikai Kumamoto HospitalKumamotoJapan
| | - Fumiko Yamauchi
- Department of NursingSaiseikai Kumamoto HospitalKumamotoJapan
| | - Eri Miyashita
- Department of NursingSaiseikai Kumamoto HospitalKumamotoJapan
| | - Tatsuya Takezaki
- Department of NeurosurgeryKumamoto University HospitalKumamotoJapan
| | - Shigeo Yamashiro
- Division of NeurosurgerySaiseikai Kumamoto HospitalKumamotoJapan
| | - Toru Nishi
- Department of NeurosurgerySakura Jyuji HospitalKumamotoJapan
| | - Jiro Machida
- Department of Medical InformationSaiseikai Kumamoto HospitalKumamotoJapan
| | - Hidehisa Soejima
- Department of InspectionSaiseikai Kumamoto HospitalKumamotoJapan
| | - Masahiro Kamouchi
- Department of Health Care Administration and Management, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
- Center for Cohort Studies, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
| | - Naoki Nakashima
- Medical Information CenterKyushu University HospitalFukuokaJapan
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Scannapieco FA. Poor Oral Health in the Etiology and Prevention of Aspiration Pneumonia. Dent Clin North Am 2021; 65:307-321. [PMID: 33641755 DOI: 10.1016/j.cden.2020.11.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Aspiration pneumonia (AP), inflammation of the lung parenchyma initiated by aspirated microorganisms into the lower airways from proximal sites, including the oral cavity, is prevalent in, and problematic for, the elderly, especially those in institutions, and for those with several important risk factors. Many factors influence the pathogenesis of AP, including dysphagia, poor oral hygiene, diminished host defense, and underlying medical conditions. This article reviews the epidemiology, microbiology, pathogenesis, and prevention of AP, focusing on the role of poor oral health as a risk factor for, and on dental care for the prevention and management of, this important infection.
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Affiliation(s)
- Frank A Scannapieco
- Department of Oral Biology, School of Dental Medicine, University at Buffalo, The State University of New York, Foster Hall, 3435 Main Street, Buffalo, NY 14214, USA.
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Ryu M, Ueda T, Sakurai K. An Interprofessional Approach to Oral Hygiene for Elderly Inpatients and the Perception of Caregivers Towards Oral Health Care. Int Dent J 2021; 71:328-335. [PMID: 33642042 PMCID: PMC9275307 DOI: 10.1016/j.identj.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate the effect of an interprofessional oral hygiene support program for elderly inpatients and the perception of caregivers of the elderly towards oral health care. MATERIALS AND METHODS Participants comprised 37 elderly inpatients requiring nursing care (17 males, 20 females; mean age, 83.3 ± 4.9 years) and 29 registered nurses who participated in the interprofessional oral health care support program as a caregiver (4 males, 25 females; mean age, 45.2 ± 10.3 years). In this program, inpatients received daily oral cleaning by registered nurses based on each patient's oral health care plan. The number of microbes on the tongue surface of the inpatients was measured once a week for 12 weeks. Additionally, as an investigation of the perception of the caregivers towards oral health care, a questionnaire about the required frequency and duration for oral cleaning was conducted with registered nurses before and after the program to investigate the perception of the caregivers towards oral health care. RESULTS Significant differences were observed in the number of microbes on the tongue surface between baseline and at every measurement after the beginning of this program, except for the first week. The mean required frequency and duration for oral cleaning by registered nurses at baseline were 1.5 ± 0.8 times and 3.8 ± 2.2 minutes, whereas those after the program were 2.7 ± 0.7 times and 5.8 ± 2.9 minutes, respectively. CONCLUSION Implementation of the program decreased the number of microbes on the tongue surface of the elderly inpatients and improved the perception of their caregivers towards oral health care.
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Affiliation(s)
- Masahiro Ryu
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan.
| | - Takayuki Ueda
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
| | - Kaoru Sakurai
- Department of Removable Prosthodontics and Gerodontology, Tokyo Dental College, Tokyo, Japan
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35
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Kataoka K, Kawabata S, Koyanagi K, Hashimoto Y, Miyake T, Fujihashi K. Respiratory FimA-Specific Secretory IgA Antibodies Upregulated by DC-Targeting Nasal Double DNA Adjuvant Are Essential for Elimination of Porphyromonas gingivalis. Front Immunol 2021; 12:634923. [PMID: 33717178 PMCID: PMC7948520 DOI: 10.3389/fimmu.2021.634923] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 01/18/2021] [Indexed: 11/13/2022] Open
Abstract
Our previous studies showed that a combination of a DNA plasmid encoding Flt3 ligand (pFL) and CpG oligodeoxynucleotides 1826 (CpG ODN) (FL/CpG) as a nasal adjuvant provoked antigen-specific immune responses. In this study, we investigated the efficacy of a nasal vaccine consisting of FimA as the structural subunit of Porphyromonas gingivalis (P. gingivalis) fimbriae and FL/CpG for the induction of FimA-specific antibody (Ab) responses and their protective roles against nasal and lung infection by P. gingivalis, a keystone pathogen in the etiology of periodontal disease. C57BL/6 mice were nasally immunized with recombinant FimA (rFimA) plus FL/CpG three times at weekly intervals. As a control, mice were given nasal rFimA alone. Nasal washes (NWs) and bronchoalveolar lavage fluid (BALF) of mice given nasal rFimA plus FL/CpG resulted in increased levels of rFimA-specific secretory IgA (SIgA) and IgG Ab responses when compared with those in controls. Significantly increased numbers of CD8- or CD11b-expressing mature-type dendritic cells (DCs) were detected in the respiratory inductive and effector tissues of mice given rFimA plus FL/CpG. Additionally, significantly upregulated Th1/Th2-type cytokine responses by rFimA-stimulated CD4+ T cells were noted in the respiratory effector tissues. When mice were challenged with live P. gingivalis via the nasal route, mice immunized nasally with rFimA plus FL/CpG inhibited P. gingivalis colonization in the nasal cavities and lungs. In contrast, controls failed to show protection. Of interest, when IgA-deficient mice given nasal rFimA plus FL/CpG were challenged with nasal P. gingivalis, the inhibition of bacterial colonization in the respiratory tracts was not seen. Taken together, these results show that nasal FL/CpG effectively enhanced DCs and provided balanced Th1- and Th2-type cytokine response-mediated rFimA-specific IgA protective immunity in the respiratory tract against P. gingivalis. A nasal administration with rFimA and FL/CpG could be a candidate for potent mucosal vaccines for the elimination of inhaled P. gingivalis in periodontal patients.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Administration, Intranasal
- Animals
- Antibodies, Bacterial/metabolism
- Bacterial Vaccines/administration & dosage
- Bacterial Vaccines/genetics
- Bacterial Vaccines/immunology
- Bacteroidaceae Infections/immunology
- Bacteroidaceae Infections/microbiology
- Bacteroidaceae Infections/prevention & control
- Disease Models, Animal
- Female
- Fimbriae Proteins/administration & dosage
- Fimbriae Proteins/genetics
- Fimbriae Proteins/immunology
- Immunity, Mucosal/drug effects
- Immunization Schedule
- Immunogenicity, Vaccine
- Immunoglobulin A, Secretory/metabolism
- Membrane Proteins/administration & dosage
- Membrane Proteins/genetics
- Membrane Proteins/immunology
- Mice, Inbred C57BL
- Oligodeoxyribonucleotides/administration & dosage
- Oligodeoxyribonucleotides/immunology
- Porphyromonas gingivalis/immunology
- Porphyromonas gingivalis/pathogenicity
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/genetics
- Recombinant Proteins/immunology
- Respiratory System/drug effects
- Respiratory System/immunology
- Respiratory System/metabolism
- Respiratory System/microbiology
- Time Factors
- Vaccines, DNA/administration & dosage
- Vaccines, DNA/immunology
- Mice
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Affiliation(s)
- Kosuke Kataoka
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Osaka Dental University, Hirakata, Japan
| | - Shigetada Kawabata
- Department of Oral and Molecular Microbiology, Graduate School of Dentistry, Osaka University, Suita, Japan
| | - Kayo Koyanagi
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Osaka Dental University, Hirakata, Japan
| | - Yoshiya Hashimoto
- Department of Biomaterials, Faculty of Dentistry, Osaka Dental University, Hirakata, Japan
| | - Tatsuro Miyake
- Department of Preventive and Community Dentistry, Faculty of Dentistry, Osaka Dental University, Hirakata, Japan
| | - Kohtaro Fujihashi
- Division of Clinical Vaccinology, International Research and Development Center for Mucosal Vaccines, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
- Department of Pediatric Dentistry, School of Dentistry, The University of Alabama at Birmingham, Birmingham, AL, United States
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Bai AV, Agostini F, Bernetti A, Mangone M, Fidenzi G, D'Urzo R, Ruggiero M, Murgia M, Santilli V, Paoloni M, Ruoppolo G, Masiero S. State of the evidence about rehabilitation interventions in patients with dysphagia. Eur J Phys Rehabil Med 2021; 57:900-911. [PMID: 33541045 DOI: 10.23736/s1973-9087.21.06716-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Rather than a separate nosological entity, dysphagia must be considered as a symptom of other pathological conditions, which afflicts patients admitted to numerous medical departments (rehabilitation, neurology, geriatrics, internal medicine, etc.) These disorders share the need for timely access to quality care and multidisciplinary treatment, including rehabilitation. The purpose of this study was to conduct a review of the current guidelines' recommendations in the literature and provide recommendations on the rehabilitative management of the patient with dysphagia. EVIDENCE ACQUISITION The search was carried out through the main databases (Medline, PEDro, Cochrane Database and Google Scholar). All the articles concerning rehabilitation management of dysphagia, published in the last 10 years, have been included. EVIDENCE SYNTHESIS Bibliographic research has provided thirteen guidelines. The literature analysed focuses mainly on the screening, the evaluation and the planning of multidisciplinary treatment. The literature agrees in recommending as cornerstones in the treatment of the dysphagic patient dietary changes, rehabilitation training (particularly muscle strengthening exercises and coordination) and early use of alternative nutrition in patients severely compromised. CONCLUSIONS The dysphagic patient requires the deployment of a range of skills by a multiprofessional and multi-disciplinary team. Speech and language pathologists in cooperation with specialists of rehabilitation have the task of managing the various stages, ranging from the early identification of the symptom to the setting of the treatment plan. Due to the lack of standardized protocols, it is necessary to implement the research path, especially regarding rehabilitation intervention.
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Affiliation(s)
- Arianna V Bai
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy -
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Gabriele Fidenzi
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Rossella D'Urzo
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Ruggiero
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Murgia
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Valter Santilli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giovanni Ruoppolo
- Department of Sensorial Organs, Sapienza University of Rome, Rome, Italy
| | - Stefano Masiero
- Department of Neuroscience, University of Padua, Padua, Italy
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Expression of the SARS-CoV-2 Receptor ACE2 and Proinflammatory Cytokines Induced by the Periodontopathic Bacterium Fusobacterium nucleatum in Human Respiratory Epithelial Cells. Int J Mol Sci 2021; 22:ijms22031352. [PMID: 33572938 PMCID: PMC7866373 DOI: 10.3390/ijms22031352] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/18/2021] [Accepted: 01/25/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is currently a global public health emergency. Periodontitis, the most prevalent disease that leads to tooth loss, is caused by infection by periodontopathic bacteria. Periodontitis is also a risk factor for pneumonia and the exacerbation of chronic obstructive pulmonary disease, presumably because of the aspiration of saliva contaminated with periodontopathic bacteria into the lower respiratory tract. Patients with these diseases have increased rates of COVID-19 aggravation and mortality. Because periodontopathic bacteria have been isolated from the bronchoalveolar lavage fluid of patients with COVID-19, periodontitis may be a risk factor for COVID-19 aggravation. However, the molecular links between periodontitis and COVID-19 have not been clarified. In this study, we found that the culture supernatant of the periodontopathic bacterium Fusobacterium nucleatum (CSF) upregulated the SARS-CoV-2 receptor angiotensin-converting enzyme 2 in A549 alveolar epithelial cells. In addition, CSF induced interleukin (IL)-6 and IL-8 production by both A549 and primary alveolar epithelial cells. CSF also strongly induced IL-6 and IL-8 expression by BEAS-2B bronchial epithelial cells and Detroit 562 pharyngeal epithelial cells. These results suggest that when patients with mild COVID-19 frequently aspirate periodontopathic bacteria, SARS-CoV-2 infection is promoted, and inflammation in the lower respiratory tract may become severe in the presence of viral pneumonia.
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Cvejic L, Guiney N, Nicholson T, Lau KK, Finlay P, Hamza K, Osadnik C, Leong P, MacDonald M, King PT, Bardin PG. Aspiration and severe exacerbations in COPD: a prospective study. ERJ Open Res 2021; 7:00735-2020. [PMID: 33532466 PMCID: PMC7836559 DOI: 10.1183/23120541.00735-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022] Open
Abstract
Rationale Swallow may be compromised in COPD leading to aspiration and adverse respiratory consequences. However, prevalence and consequences of detectable aspiration in stable COPD are not known. Objectives We tested the hypothesis that a significant number of patients with stable COPD will have detectable aspiration during swallow (prandial aspiration) and that they would experience more frequent severe acute exacerbations of COPD (AECOPD) over the subsequent 12 months. Methods Patients (n=151) with verified and stable COPD of all severities were recruited at a tertiary care hospital. Videofluoroscopy was conducted to evaluate aspiration using Rosenbek's scale for penetration–aspiration during 100-mL cup drinking. AECOPD was documented as moderate (antibiotics and/or corticosteroid treatment) or severe (emergency department admission or hospitalisation) over the ensuing 12 months. Measurements and main results Aspiration was observed in 30 out of 151 patients (19.9%, 18 males, 12 females; mean age 72.4 years). Patients with aspiration had more overall AECOPD events (3.03 versus 2 per patient; p=0.022) and severe AECOPD episodes (0.87 versus 0.39; p=0.032). Severe AECOPD occurred in more patients with aspiration (50% of patients versus 18.2%; OR 4.5, CI 1.9–10.5; p=0.001) and with silent aspiration (36.7% versus 18.2%; OR 2.6, CI 1.1–6.2; p=0.045). Aspiration was related to a shorter exacerbation-free period during the 12-month follow-up period (p=0.038). Conclusions Prandial aspiration is detectable in a subset of patients with COPD and was predictive of subsequent severe AECOPD. Studies to examine if the association is causal are essential to direct strategies aimed at prevention of aspiration and AECOPD. This study demonstrates that prandial aspiration occurs in ∼20% of patients with stable COPD and portends severe COPD exacerbations over the next 12 monthshttps://bit.ly/2Tx5btj
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Affiliation(s)
- Lydia Cvejic
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Nadine Guiney
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | | | - Kenneth K Lau
- School of Clinical Sciences, Monash University, Melbourne, Australia.,Diagnostic Imaging, Monash Health, Melbourne, Australia
| | - Paul Finlay
- Monash Lung and Sleep, Monash Health, Melbourne, Australia
| | - Kais Hamza
- School of Mathematical Sciences, Monash University, Melbourne, Australia
| | - Christian Osadnik
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul Leong
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Martin MacDonald
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Paul T King
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
| | - Philip G Bardin
- Monash Lung and Sleep, Monash Health, Melbourne, Australia.,School of Clinical Sciences, Monash University, Melbourne, Australia.,Hudson Institute and Monash University, Melbourne, Australia
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Konstantopoulou K, Kossioni A, Karkazis H, Polyzois G. Implementation and evaluation of an oral health education programme for caregivers in nursing homes. SPECIAL CARE IN DENTISTRY 2021; 41:154-163. [PMID: 33382125 DOI: 10.1111/scd.12558] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
AIM The aim was the design, implementation, and evaluation of an oral health education program for nursing home caregivers. METHODS AND RESULTS Fifty-five formal caregivers working in the three units of a nursing home were allocated to either a control (n = 27) or an intervention group (n = 28). A knowledge and attitudes questionnaire about oral health was developed and completed by the caregivers. Then, an education program about oral heath in older people was applied to the intervention group, and the completion of the questionnaire was repeated by both the intervention and control groups. Two months after the intervention, the questionnaire was completed again by the intervention group. Within groups analyses revealed a statistically significant increase in knowledge and attitudes only in the intervention group after the implementation of the education program (P < .001). Between-group analyses showed that the total knowledge and attitudes score in the intervention group were statistically significantly higher than in the control group (P < .001 and P = .02, respectively). In the intervention group, knowledge and attitudes were maintained in the measurement recorded 2 months later (P = .11 and P = .21, respectively). CONCLUSION The education program was effective in improving the caregivers' knowledge and attitudes toward nursing home residents' oral health and maintaining them 2 months after implementation.
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Affiliation(s)
- Kalliopi Konstantopoulou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastassia Kossioni
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Hercules Karkazis
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Gregory Polyzois
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
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40
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Kwapisz E, Garbacz K, Kosecka-Strojek M, Schubert J, Bania J, Międzobrodzki J. Presence of egc-positive major clones ST 45, 30 and 22 among methicillin-resistant and methicillin-susceptible oral Staphylococcus aureus strains. Sci Rep 2020; 10:18889. [PMID: 33144661 PMCID: PMC7609576 DOI: 10.1038/s41598-020-76009-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/22/2020] [Indexed: 02/06/2023] Open
Abstract
The oral cavity may comprise a significant reservoir for Staphylococcus aureus but the data on molecular epidemiology and clonal distribution of oral strains are really scarce. This study aimed to evaluate the clonal relatedness in S. aureus isolated from oral cavity and their relationship with carriage of virulence genes, and antimicrobial resistance profiles. A total of 139 oral S. aureus isolates were obtained from 2327 analysed oral samples of dental patients. Antimicrobial susceptibility testing was performed. Isolates were characterized using protein A gene (spa) typing, spa-CC clonal complexes, toxin genes and SCCmec typing for MRSA. High resistance rates for penicillin, tetracycline and gentamicin were detected, respectively 58.3%, 42.4%, and 35.2%. Twelve (8.6%) S. aureus isolates were identified as MRSA. All of MRSA isolates were mecA-positive and mecC-negative. SCCmec IV was the most common type (66.7%), which was typical for community-acquired MRSA (CA-MRSA). Overall, the enterotoxin gene cluster (egc) was the most frequent detected virulence factor (44.9%), both in MSSA and MRSA isolates. Presence of genes encoding for the enterotoxins (sea, seb, sec, seh, sek), exfoliative toxin A (eta), and toxic shock syndrome toxin-1 (tst) was also observed. Strains carrying lukS-PV/lukF-PV genes belonged to SCCmecV- spa type t437. The most prevalent spa types were t091, t015, t084, t002, t571, and t026 among all 57 identified. Spa types, including 3 new ones, grouped in 6 different spa-CC clonal complexes, with four major dominated; CC45, CC30, CC5, and CC15. This study demonstrated that both methicillin-susceptible and methicillin-resistant major European clones of S. aureus could be isolated from the oral cavity of dental patients, with the emergence of PVL-positive CA-MRSA strains. The oral cavity should be considered as a possible source of toxigenic egc-positive S. aureus strains, in terms of potential risk of cross-infection and dissemination to other body sites.
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Affiliation(s)
- Ewa Kwapisz
- Department of Oral Microbiology, Medical Faculty, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Garbacz
- Department of Oral Microbiology, Medical Faculty, Medical University of Gdansk, Gdansk, Poland.
| | - Maja Kosecka-Strojek
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Justyna Schubert
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Jacek Bania
- Department of Food Hygiene and Consumer Health Protection, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Jacek Międzobrodzki
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
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41
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Exposure to Porphyromonas gingivalis Induces Production of Proinflammatory Cytokine via TLR2 from Human Respiratory Epithelial Cells. J Clin Med 2020; 9:jcm9113433. [PMID: 33114582 PMCID: PMC7693763 DOI: 10.3390/jcm9113433] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/19/2020] [Accepted: 10/22/2020] [Indexed: 12/25/2022] Open
Abstract
Aspiration pneumonia is a major health problem owing to its high mortality rate in elderly people. The secretion of proinflammatory cytokines such as interleukin (IL)-8 and IL-6 by respiratory epithelial cells, which is induced by infection of respiratory bacteria such as Streptococcus pneumoniae, contributes to the onset of pneumonia. These cytokines thus play a key role in orchestrating inflammatory responses in the lower respiratory tract. In contrast, chronic periodontitis, a chronic inflammatory disease caused by the infection of periodontopathic bacteria, typically Porphyromonas gingivalis, is one of the most prevalent microbial diseases affecting humans globally. Although emerging evidence has revealed an association between aspiration pneumonia and chronic periodontitis, a causal relationship between periodontopathic bacteria and the onset of aspiration pneumonia has not been established. Most periodontopathic bacteria are anaerobic and are therefore unlikely to survive in the lower respiratory organs of humans. Therefore, in this study, we examined whether simple contact by heat-inactivated P. gingivalis induced proinflammatory cytokine production by several human respiratory epithelial cell lines. We found that P. gingivalis induced strong IL-8 and IL-6 secretion by BEAS-2B bronchial epithelial cells. P. gingivalis also induced strong IL-8 secretion by Detroit 562 pharyngeal epithelial cells but not by A549 alveolar epithelial cells. Additionally, Toll-like receptor (TLR) 2 but not TLR4 was involved in the P. gingivalis-induced proinflammatory cytokine production. Furthermore, P. gingivalis induced considerably higher IL-8 and IL-6 production than heat-inactivated S. pneumoniae. Our results suggest that P. gingivalis is a powerful inflammatory stimulant for human bronchial and pharyngeal epithelial cells and can stimulate TLR2-mediated cytokine production, thereby potentially contributing to the onset of aspiration pneumonia.
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Marin-Corral J, Pascual-Guardia S, Amati F, Aliberti S, Masclans JR, Soni N, Rodriguez A, Sibila O, Sanz F, Sotgiu G, Anzueto A, Dimakou K, Petrino R, van de Garde E, Restrepo MI. Aspiration Risk Factors, Microbiology, and Empiric Antibiotics for Patients Hospitalized With Community-Acquired Pneumonia. Chest 2020; 159:58-72. [PMID: 32687909 DOI: 10.1016/j.chest.2020.06.079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Aspiration community-acquired pneumonia (ACAP) and community-acquired pneumonia (CAP) in patients with aspiration risk factors (AspRFs) are infections associated with anaerobes, but limited evidence suggests their pathogenic role. RESEARCH QUESTION What are the aspiration risk factors, microbiology patterns, and empiric anti-anaerobic use in patients hospitalized with CAP? STUDY DESIGN AND METHODS This is a secondary analysis of GLIMP, an international, multicenter, point-prevalence study of adults hospitalized with CAP. Patients were stratified into three groups: (1) ACAP, (2) CAP/AspRF+ (CAP with AspRF), and (3) CAP/AspRF- (CAP without AspRF). Data on demographics, comorbidities, microbiological results, and anti-anaerobic antibiotics were analyzed in all groups. Patients were further stratified in severe and nonsevere CAP groups. RESULTS We enrolled 2,606 patients with CAP, of which 193 (7.4%) had ACAP. Risk factors independently associated with ACAP were male, bedridden, underweight, a nursing home resident, and having a history of stroke, dementia, mental illness, and enteral tube feeding. Among non-ACAP patients, 1,709 (70.8%) had CAP/AspRF+ and 704 (29.2%) had CAP/AspRF-. Microbiology patterns including anaerobes were similar between CAP/AspRF-, CAP/AspRF+ and ACAP (0.0% vs 1.03% vs 1.64%). Patients with severe ACAP had higher rates of total gram-negative bacteria (64.3% vs 44.3% vs 33.3%, P = .021) and lower rates of total gram-positive bacteria (7.1% vs 38.1% vs 50.0%, P < .001) when compared with patients with severe CAP/AspRF+ and severe CAP/AspRF-, respectively. Most patients (>50% in all groups) independent of AspRFs or ACAP received specific or broad-spectrum anti-anaerobic coverage antibiotics. INTERPRETATION Hospitalized patients with ACAP or CAP/AspRF+ had similar anaerobic flora compared with patients without aspiration risk factors. Gram-negative bacteria were more prevalent in patients with severe ACAP. Despite having similar microbiological flora between groups, a large proportion of CAP patients received anti-anaerobic antibiotic coverage.
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Affiliation(s)
- Judith Marin-Corral
- Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Sergi Pascual-Guardia
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Respiratory Department, Hospital del Mar, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Francesco Amati
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Stefano Aliberti
- Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, and University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Joan R Masclans
- Critical Care Department, Hospital del Mar, Barcelona, Spain, and the Critical Illness Research Group (GREPAC), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Nilam Soni
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Alejandro Rodriguez
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Critical Care Medicine, Hospital Universitari Joan XXIII and Rovira & Virgili University, Tarragona, Spain
| | - Oriol Sibila
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain; Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and University of Barcelona, Barcelona, Spain
| | - Francisco Sanz
- Pulmonology Department, Consorci Hospital General Universitari de Valencia, Valencia, Spain
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Antonio Anzueto
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX
| | - Katerina Dimakou
- 5th Department of Pulmonary Medicine, Sotiria Chest Diseases Hospital, Athens, Greece
| | | | - Ewoudt van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Marcos I Restrepo
- Division of Pulmonary Diseases & Critical Care Medicine, University of Texas Health San Antonio, San Antonio, TX; Section of Pulmonary & Critical Care Medicine, South Texas Veterans Health Care System, San Antonio, TX.
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Yoshimatsu Y, Tobino K, Ko Y, Yasuda M, Ide H, Oku Y. Careful history taking detects initially unknown underlying causes of aspiration pneumonia. Geriatr Gerontol Int 2020; 20:785-790. [DOI: 10.1111/ggi.13978] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Yuki Yoshimatsu
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
- Department of PhysiologyHyogo College of Medicine Nishinomiya Japan
| | - Kazunori Tobino
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
- Department of Respiratory MedicineJuntendo University Graduate School of Medicine Tokyo Japan
| | - Yuki Ko
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
| | - Mina Yasuda
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
| | - Hiromi Ide
- Department of Respiratory MedicineIizuka Hospital Iizuka Japan
| | - Yoshitaka Oku
- Department of PhysiologyHyogo College of Medicine Nishinomiya Japan
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Association between oral health and incidence of pneumonia: a population-based cohort study from Korea. Sci Rep 2020; 10:9576. [PMID: 32533077 PMCID: PMC7293333 DOI: 10.1038/s41598-020-66312-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022] Open
Abstract
Pneumonia is related to oral health of the elderly and intensive care unit patients. However, studies on the relationship between overall oral health and pneumonia in the general population have been limited. The purpose of this study was to investigate the association between oral health and pneumonia using a nationwide population-based Korean cohort database. Data from 122,251 participants who underwent health screening and oral examinations in 2004 or 2005 were analyzed. Cox proportional hazard regression analysis was performed to evaluate the association between oral health and pneumonia. The risk of pneumonia increased significantly in groups with a higher number of dental caries and missing teeth, with respective adjusted hazard ratios (HRs) and 95% confidence interval (CI) of 1.265 (1.086–1.473; p = 0.0025) and 1.218 (1.113–1.332; p < 0.0001), and decreased significantly in frequent tooth brushing and regular professional dental cleaning groups, with respective adjusted HRs and 95% CI of 0.853 (0.786–0.926; p = 0.0001) and 0.920 (0.855–0.990; p = 0.0255). In addition, regardless of age and comorbidities, oral health status and oral hygiene behaviors were associated with pneumonia. The results indicate that improved oral health may reduce the risk of pneumonia in the general population.
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The effect of oral care intervention on pneumonia hospitalization, Staphylococcus aureus distribution, and salivary bacterial concentration in Taiwan nursing home residents: a pilot study. BMC Infect Dis 2020; 20:374. [PMID: 32460697 PMCID: PMC7251833 DOI: 10.1186/s12879-020-05061-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background Elevated Staphylococcus aureus and oral bacterial concentrations are known to correlate with pneumonia hospitalization in nursing home residents. However, the effects of a professional oral care intervention on these factors remain unclear. The aims of this quasi-experimental study were to compare bacterial concentrations in saliva and sputum, oral health status, distribution of Staphylococcus aureus, and pneumonia status before and after a professional oral care intervention. Methods A purposive sample of residents from two nursing homes was divided into an intervention group that received a weekly professional oral care intervention and a control group. Oral bacterial concentration was determined by real-time polymerase chain reaction. The Staphylococcus aureus distribution was determined by bacterial culture and matrix-assisted laser desorption/ionization–time of flight mass spectrometry. After data collection, a statistical analysis was performed to evaluate the effect of the intervention. Results Most residents were unconscious (80%), and most had a history of pneumonia (76%). Baseline demographic data did not significantly differ between the two groups. After the intervention, the intervention group had significant improvements in plaque index (1.66 ± 0.78 vs. 0.94 ± 0.64, p < 0.01), gingival index (2.36 ± 0.76 vs. 1.65 ± 0.83, p < 0.01), tongue coating index (0.96 ± 1.10 vs. 0.16 ± 0.47, p < 0.01), distribution of Staphylococcus aureus in salivary samples (11.11 ± 14.47% vs. 1.74 ± 3.75%, p = 0.02), and salivary bacterial concentration ([4.27 ± 3.65] × 105 vs. [0.75 ± 1.20] × 105, p < 0.01). Sputum bacterial concentration did not significantly differ. The intervention group also had a significantly lower annual prevalence of pneumonia hospitalization (1.24 ± 1.51 vs. 0.48 ± 0.59, p = 0.01), especially in residents whose salivary bacterial concentration exceeded the median. However, the duration of pneumonia hospitalization did not significantly differ between the two groups. Conclusion A professional oral care intervention in nursing home residents can improve oral health, reduce levels of salivary bacteria and Staphylococcus aureus, and decrease the annual prevalence of pneumonia hospitalization. Trial registration Trial registration: ClinicalTrials.gov, NCT03874962. Registered 12 March 2019 - Retrospectively registered.
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Evaluation of effects of perioperative oral care intervention on hospitalization stay and postoperative infection in patients undergoing lung cancer intervention. Support Care Cancer 2020; 29:135-143. [PMID: 32323001 DOI: 10.1007/s00520-020-05450-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This retrospective study investigated the effect of perioperative oral care intervention on postoperative outcomes in patients undergoing lung cancer resection, in terms of the length of postoperative hospital stay and the incidence of postoperative respiratory infections. METHODS In total, 585 patients underwent lung resection for lung cancer, 397 received perioperative oral care intervention, whereas the remaining 188 did not. This study retrospectively investigated the demographic and clinical characteristics (including postoperative complications and postoperative hospital stay) of each group. To determine whether perioperative oral care intervention was independently associated with either postoperative hospital stay or postoperative respiratory infections, multivariate analysis, multiple regression analysis, and multivariate logistic regression analysis were conducted. RESULTS Parameters significantly associated with a prolonged postoperative hospital stay in lung cancer surgery patients were older age, postoperative complications, increased intraoperative bleeding, more invasive operative approach (e.g., open surgery), and lack of perioperative oral care intervention (standard partial regression coefficient (ß) = 0.083, p = 0.027). Furthermore, older age and longer operative time were significant independent risk factors for the occurrence of postoperative respiratory infections. Lack of perioperative oral care intervention was a potential risk factor for the occurrence of postoperative respiratory infections, although not statistically significant (odds ratio = 2.448, 95% confidence interval = 0.966-6.204, p = 0.059). CONCLUSION These results highlight the importance of perioperative oral care intervention prior to lung cancer surgery, in order to shorten postoperative hospital stay and reduce the risk of postoperative respiratory infections.
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Teixeira CGDS, Sanitá PV, Ribeiro APD, Dias LM, Jorge JH, Pavarina AC. Antimicrobial photodynamic therapy effectiveness against susceptible and methicillin-resistant Staphylococcus aureus biofilms. Photodiagnosis Photodyn Ther 2020; 30:101760. [PMID: 32283312 DOI: 10.1016/j.pdpdt.2020.101760] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Staphylococcus aureus have a great ability to become rapidly resistant to conventional antimicrobial therapies. This study evaluated the efficacy of antimicrobial photodynamic therapy (aPDT) mediated by Curcumin (Cur) and light-emitting diode (LED) in the inactivation of biofilms of methicillin susceptible and resistant S. aureus (MSSA and MRSA, respectively). METHODS Biofilms were treated with Cur (20, 40 or 80 μM) and illuminated with LED source (455 ± 3 nm; 5.28 J/cm2) (aPDT groups), or treated either with Cur or LED only. Other samples were not exposed to Cur or LED (negative control). The biofilms viability after all experimental conditions were evaluated by counting the number of colonies (CFU/mL) and XTT assay. Additional samples were also evaluated by LIVE/DEAD® staining using confocal laser scanning microscopy (CLSM). Data were analyzed by ANOVAs followed by the Games-Howell post hoc test (α = 0.05). RESULTS For both strains, all aPDT groups significantly reduced both CFU/mL and metabolic activity of biofilms compared to the negative control (p < 0.001). The results were enhanced when 80 μM of Cur was used. CLSM images showed that both bacteria biofilms submitted to aPDT had a large number of red-stained colonies, especially at aPDT80. In general, MRSA biofilms tended to be less susceptible to aPDT than MSSA biofilms. CONCLUSIONS It can be concluded that aPDT mediated by Cur and LED was an efficient method to inactivate 48 -h biofilms of both S. aureus strains.
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Affiliation(s)
- Camilo Geraldo de Souza Teixeira
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Rua Humaitá, 1680, 14801-903, Araraquara, SP, Brazil
| | - Paula Volpato Sanitá
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Rua Humaitá, 1680, 14801-903, Araraquara, SP, Brazil
| | - Ana Paula Dias Ribeiro
- Department of Restorative Dental Sciences, College of Dentistry, University of Florida, Center Dr. 1395, Gainesville, 32610, FL, USA
| | - Luana Mendonça Dias
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Rua Humaitá, 1680, 14801-903, Araraquara, SP, Brazil
| | - Janaina Habib Jorge
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Rua Humaitá, 1680, 14801-903, Araraquara, SP, Brazil
| | - Ana Cláudia Pavarina
- Department of Dental Materials and Prosthodontics, School of Dentistry, São Paulo State University (UNESP), Rua Humaitá, 1680, 14801-903, Araraquara, SP, Brazil.
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The Association of Periodontal Treatment and Decreased Pneumonia: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010356. [PMID: 31948027 PMCID: PMC6982322 DOI: 10.3390/ijerph17010356] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/25/2019] [Accepted: 01/02/2020] [Indexed: 12/21/2022]
Abstract
Pneumonia is a common respiratory infectious disease that involves the inflammation of the pulmonary parenchyma. Periodontal disease is widespread and correlated with pneumonia. However, the relationship between periodontal treatment and clinical infectious outcomes in patients with pneumonia has remained undetermined. The aim of this study was to investigate the association between periodontal treatment and the risk of pneumonia events in the Taiwanese population. A nationwide population-based cohort study was conducted using data from the Taiwanese National Health Insurance Research Database (NHIRD). A total of 49,400 chronic periodontitis patients who received periodontal treatment from 2001 to 2012 were selected. In addition, 49,400 healthy individuals without periodontal diseases were picked randomly from the general population after propensity score matching according to age, gender, monthly income, urbanization, and comorbidities. The Cox proportional hazard regression analysis was adopted to assess the hazard ratio (HR) of pneumonia between the periodontal treatment cohort and the comparison cohort. The average ages of the periodontal treatment and comparison groups were 44.25 ± 14.82 years and 44.15 ± 14.5 years, respectively. The follow up durations were 7.66 and 7.41 years for the periodontal treatment and comparison groups, respectively. We found 2504 and 1922 patients with newly diagnosed pneumonia in the comparison cohort and the periodontal treatment cohort, respectively. The Kaplan–Meier plot revealed that the cumulative incidence of pneumonia was significantly lower over the 12 year follow-up period in the periodontal treatment group (using the log-rank test, p < 0.001). In conclusion, this nationwide population-based study indicated that the patients with periodontal treatment exhibited a significantly lower risk of pneumonia than the general population.
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Hartanto F, Dewi T. Association of oral health status with the risk of malnutrition and pneumonia in geriatric patients. SCIENTIFIC DENTAL JOURNAL 2020. [DOI: 10.4103/sdj.sdj_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Perry SE, Huckabee M, Tompkins G, Milne T. The association between oral bacteria, the cough reflex and pneumonia in patients with acute stroke and suspected dysphagia. J Oral Rehabil 2019; 47:386-394. [DOI: 10.1111/joor.12903] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/01/2019] [Accepted: 10/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah E. Perry
- The University of Canterbury Rose Centre for Stroke Recovery & Research at St George’s Medical Centre Christchurch New Zealand
- University of Canterbury Christchurch New Zealand
| | - Maggie‐Lee Huckabee
- The University of Canterbury Rose Centre for Stroke Recovery & Research at St George’s Medical Centre Christchurch New Zealand
- University of Canterbury Christchurch New Zealand
- Sir John Walsh Research Institute University of Otago Dunedin New Zealand
| | - Geoffrey Tompkins
- Sir John Walsh Research Institute University of Otago Dunedin New Zealand
| | - Trudy Milne
- Sir John Walsh Research Institute University of Otago Dunedin New Zealand
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