Positive predictive value of urine analysis with reflex criteria at a large community hospital

INTRODUCTION AND HYPOTHESIS

Urine analysis with reflex to culture (URTC) is employed as a diagnostic aid for urinary tract infections (UTIs). Criteria utilized to determine whether a urine analysis (UA) will reflex varies owing to a lack of evidence-based guidance. Positive predictive value (PPV) of URTC varies across studies. The URTC criteria in this study included moderate or more white blood cells (> 5 high-power field [HPF]), few or more bacteria (> 1 HPF), and few or no epithelial cells (< 3 HPF). The purpose of this study was to determine the extent to which URTC predicts culture positivity.

METHODS

This study was a single-center, retrospective evaluation at a large community hospital. A report of URTC ordered in adults in October 2020 was generated from the hospital's electronic database. The primary outcome was to determine the PPV of URTC criteria. The secondary outcome was to examine the differences in microscopic UA results between culture-positive and culture-negative urine. A total of 350 patients were included for analysis. The data was analyzed through descriptive statistics, Mann-Whitney U test, and multivariate logistic regression.

RESULTS

The results showed a PPV of 58%. Variables predicting negative culture included younger patients, males, and a reason for the visit to the emergency department of a fall/syncope or other.

CONCLUSIONS

Further optimization is needed for URTC criteria and the appropriateness of ordering UAs to reduce operational laboratory costs and inappropriate antibiotic treatment.

Clozapine but not lithium reverses aberrant tyrosine uptake in patients with bipolar disorder

RATIONALE

Availability of the dopamine and noradrenaline precursor tyrosine is critical for normal functioning, and deficit in tyrosine transport across cell membrane and the blood-brain barrier has been reported in bipolar disorder and schizophrenia. Clozapine and lithium are two psychoactive agents used to treat psychosis, mood disorders and suicidal behavior, but their mechanism of action remains largely unknown.

OBJECTIVE

To characterize immediate and delayed differences in tyrosine uptake between healthy controls (HC) and bipolar patients (BP) and see if these differences could be normalized by either clozapine, lithium or both. A second objective was to see if clozapine and lithium have additive, antagonistic or synergistic effects in this.

METHOD

Fibroblasts from five HC and five BP were incubated for 5 min or 6 h with clozapine, lithium, or combination of both. Radioactive labelled tyrosine was used to quantify tyrosine membrane transport.

RESULTS

There was significantly reduced tyrosine uptake at baseline in BP compared to HC, a deficit that grew with increasing incubation time. Clozapine selectively increased tyrosine uptake in BP and abolished the deficit seen under baseline conditions, while lithium had no such effect. Combination treatment with clozapine and lithium was less effective than when clozapine was used alone.

CONCLUSIONS

There was significant deficit in tyrosine transport in BP compared to HC that was reversed by clozapine but not lithium. Clozapine was more effective when used alone than when added together with lithium. Potential clinical implications of this will be discussed.

Impact of Pharmacists to Improve Patient Care in the Critically Ill: A Large Multicenter Analysis Using Meaningful Metrics With the Medication Regimen Complexity-ICU (MRC-ICU) Score

OBJECTIVES

Despite the established role of the critical care pharmacist on the ICU multiprofessional team, critical care pharmacist workloads are likely not optimized in the ICU. Medication regimen complexity (as measured by the Medication Regimen Complexity-ICU [MRC-ICU] scoring tool) has been proposed as a potential metric to optimize critical care pharmacist workload but has lacked robust external validation. The purpose of this study was to test the hypothesis that MRC-ICU is related to both patient outcomes and pharmacist interventions in a diverse ICU population.

DESIGN

This was a multicenter, observational cohort study.

SETTING

Twenty-eight ICUs in the United States.

PATIENTS

Adult ICU patients.

INTERVENTIONS

Critical care pharmacist interventions (quantity and type) on the medication regimens of critically ill patients over a 4-week period were prospectively captured. MRC-ICU and patient outcomes (i.e., mortality and length of stay [LOS]) were recorded retrospectively.

MEASUREMENTS AND MAIN RESULTS

A total of 3,908 patients at 28 centers were included. Following analysis of variance, MRC-ICU was significantly associated with mortality (odds ratio, 1.09; 95% CI, 1.08-1.11; p < 0.01), ICU LOS (β coefficient, 0.41; 95% CI, 00.37-0.45; p < 0.01), total pharmacist interventions (β coefficient, 0.07; 95% CI, 0.04-0.09; p < 0.01), and a composite intensity score of pharmacist interventions (β coefficient, 0.19; 95% CI, 0.11-0.28; p < 0.01). In multivariable regression analysis, increased patient: pharmacist ratio (indicating more patients per clinician) was significantly associated with increased ICU LOS (β coefficient, 0.02; 0.00-0.04; p = 0.02) and reduced quantity (β coefficient, -0.03; 95% CI, -0.04 to -0.02; p < 0.01) and intensity of interventions (β coefficient, -0.05; 95% CI, -0.09 to -0.01).

CONCLUSIONS

Increased medication regimen complexity, defined by the MRC-ICU, is associated with increased mortality, LOS, intervention quantity, and intervention intensity. Further, these results suggest that increased pharmacist workload is associated with decreased care provided and worsened patient outcomes, which warrants further exploration into staffing models and patient outcomes.

Safety of a Nurse-Driven Standardized Potassium Replacement Protocol in Critically Ill Patients With Renal Insufficiency

BACKGROUND

In critically ill patients, maintaining appropriate serum potassium concentrations requires careful supplementation to correct hypokalemia but avoid hyperkalemia. At the study institution, an institution-based, nurse-driven standardized electrolyte replacement protocol is used in critically ill patients with a serum creatinine concentration of 2 mg/dL or less. If the serum creatinine concentration is greater than 2 mg/dL, electrolyte replacement requires a physician order.

OBJECTIVE

To determine if standardized potassium supplementation is safe in critically ill patients with renal insufficiency not requiring renal replacement therapy.

METHODS

This study was an institutional review board-approved, single-center, retrospective evaluation of critically ill patients receiving intravenous potassium replacement per protocol. Patients were grouped according to serum creatinine concentration (≤ 2 mg/dL or > 2 mg/dL) at the time of replacement. The primary outcome was the incidence of hyperkalemia (potassium concentration ≥ 5 mEq/L) following potassium replacement. Secondary outcomes were the incidence of hyperkalemia, change in serum potassium concentration, and need for hyperkalemia treatment. Outcomes were analyzed using χ2 and t tests.

RESULTS

Of 814 patients screened, 145 were included (99 with serum creatinine ≤ 2 mg/dL and 46 with serum creatinine > 2 mg/dL). The incidence of hyperkalemia was not different between groups (P = .57). Five patients experienced hyperkalemia; none received hyperkalemia treatment. Change in serum potassium was similar for patients in the 2 groups (P = .33).

CONCLUSIONS

A standardized, nurse-driven electrolyte replacement protocol can be used safely in critically ill patients with renal insufficiency not requiring renal replacement therapy.

A multicenter and observational study of the Ambu™ AuraGain™ laryngeal mask in adult patients

PURPOSE

The main objective of this study was to evaluate the performance of the Ambu™ AuraGain™ device by determining its main parameters of use and complications.

METHODS

A total of 250 adult ASA physical status i to iii patients from five hospitals in Spain who received general anaesthesia with a supraglottic airway (SGA) device were enrolled in this study.

RESULTS

The primary outcome was analysed for 244 patients and a median OLP of 32 cm H2O (IQR 28-36 cm H2O) was obtained. Insertion was achieved at first attempt in 85% of cases, and overall in 98% of cases, in a median time of 15 s (12-22.5). We applied manoeuvres in 61% of patients to facilitate the process. Ventilation was effective in 97.2% of the interventions (95% CI 0.99-0.94) throughout the procedure. Insertion of the gastric tube was easily performed in 99.6% of the patients, and the vocal cords were viewed by fibrobronchoscopy in 96.3% of cases. Logistic regression analysis identified the use of sizes smaller than those recommended as a risk factor for low OLP (< 25 cm H2O). The main complication recorded was the presence of blood when withdrawing the SGA device (15%).

CONCLUSIONS

Our results confirm that the use of AuraGain allows airway management in a reliable and effective way achieving high OLP and low incidence of associated complications, establishing it as a useful alternative in the routine clinical setting of anaesthesiologists. AuraGain performance was consistent in all five centres.

Associated factors with health-compromising behaviors among patients treated for oral cancer

BACKGROUND

To improve eradication strategies of health-compromising behaviors between oral cancer survivors, this study aimed to explore the extent of clustering of risk behaviors and to assess possible factors associated.

MATERIAL AND METHODS

A cross-sectional study was carried out among oral cancer patients at least 6 months after treatment. They completed a questionnaire about smoking, alcohol consumption, oral hygiene habits and dental visits. Presence of clusters was evaluated through pairwise Pearson correlations and principal component analysis. Factors associated with each identified cluster were analyzed with multivariate models.

RESULTS

Among 142 patients, 14.8% smoked, 51.7% consumed alcohol, 52.1% performed oral hygiene less than twice a day, and 74.6% visited to dentist when there was a problem or never. There were two distinct clusters: smoking-alcohol consumption (general risk behaviors cluster) and oral hygiene-dental attendance (oral risk behaviors cluster). Multivariate analysis showed significant associations between males and both clustering patterns of health compromising behaviors, patients with clinical stage I or with longer follow-up and the presence of general risk behaviors cluster and worse social class and the presence of oral risk behaviors cluster.

CONCLUSIONS

A high proportion of patients treated for oral cancer presented health-compromising behaviors occurring in clusters which reinforce the need for health promotion strategies to target multiple behaviors. Factors analyzed suggest that chances of having detrimental behavioral clustering are higher in male, patients with clinical stage I, with lower social class and those with longer follow-up after treatment.

Observational pilot study of patients with carpal tunnel syndrome treated with Nucleo CMP Forte™

AIM

Carpal tunnel syndrome (CTS) is a very common entrapment neuropathy characterized by pain and paresthesia in the territory of the median nerve. Although this syndrome has a considerable impact on the patient's quality of life, its medical treatment is far from optimal.

MATERIAL & METHODS

We performed an observational study to evaluate Nucleo CMP Forte^TM in patients with electromyography-confirmed, mild-moderate CTS. Pain was assessed using a visual analog scale, electromyogram and the SF-36.

RESULTS

Pain decreased significantly after 6 months. Quality of life improved significantly in the pain dimensions. No significant differences were observed in electromyographic findings. No adverse events were reported.

CONCLUSIONS

Nucleotides could prove useful for the nonsurgical treatment of CTS. Further studies are necessary to confirm this.

Oral health in Alzheimer's disease: a multicenter case-control study

OBJECTIVES

The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health.

MATERIALS AND METHODS

A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed.

RESULTS

Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%).

CONCLUSIONS

After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality.

CLINICAL RELEVANCE

Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

Early electrophysiological findings in Fisher-Bickerstaff syndrome

INTRODUCTION

The term Fisher-Bickerstaff syndrome (FBS) has been proposed to describe the clinical spectrum encompassing Miller-Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis. The pathophysiology of FBS and the nature of the underlying neuropathy (demyelinating or axonal) are still subject to debate. This study describes the main findings of an early neurophysiological study on 12 patients diagnosed with FBS.

PATIENTS AND METHODS

Retrospective evaluation of clinical characteristics and electrophysiological findings of 12 patients with FBS seen in our neurology department within 10 days of disease onset. Follow-up electrophysiological studies were also evaluated, where available.

RESULTS

The most frequent electrophysiological finding, present in 5 (42%) patients, was reduced sensory nerve action potential (SNAP) amplitude in one or more nerves. Abnormalities were rarely found in motor neurography, with no signs of demyelination. The cranial nerve exam revealed abnormalities in 3 patients (facial neurography and/or blink reflex test). Three patients showed resolution of SNAP amplitude reduction in serial neurophysiological studies, suggesting the presence of reversible sensory nerve conduction block. Results from cranial MRI scans were normal in all patients.

CONCLUSION

An electrophysiological pattern of sensory axonal neuropathy, with no associated signs of demyelination, is an early finding of FBS. Early neurophysiological evaluation and follow-up are essential for diagnosing patients with FBS.

Personality traits and dental anxiety in self-reported bruxism. A cross-sectional study

OBJECTIVES

The aim of this study was to investigate the association between psychological factors (Personality and Dental anxiety) with self-reported bruxism-related symptoms.

METHODS

526 subjects, over 18 years old and not seeking dental treatment, were recruited from the families and acquaintances of dental students from the University of Salamanca. Bruxism activity was estimated by means of a six-item questionnaire aimed at recording common bruxism-related symptoms and clenching/grinding awareness. The Spanish version of the modified dental anxiety scale (MDAS) was used to determine the level of anxiety perceived in 5 typical scenarios of dental assistance. The NEO-FFI inventory was applied to assess personality profiles associated with 5 different factors (neuroticism, extroversion, openness, agreeableness, and conscientiousness). Pearson correlations, Student T-tests, and logistic regression modelling were used for the statistical analyses.

RESULTS

Thirty-five point nine percent of this adults sample was classified as being bruxers, where sleep bruxers comprised more than half of the sample at 20.2%. Bruxers tended to perceive more anxiety in all of the situations included within the MDAS, where they exhibited a higher level of phobia towards the teeth scaling and local anaesthetic injection. The risk of being considered a bruxer is reduced with age (OR: 0.99), and increases proportionally for some personality traits, such as neuroticism (OR: 1.06) and extraversion(OR: 1.04), to the MDAS total score (OR: 1.08) and in smokers (OR: 1.61), after controlling for all potentially confounding factors.

CONCLUSIONS

Self-reported bruxism is significantly associated to several personality traits (mainly neuroticism and extraversion) and to the level of dental anxiety (MDAS score).

CLINICAL SIGNIFICANCE

Clinicians should be aware of the typical psychological profiles of patients who experience bruxism and the relationship with dental phobias.

Histamine and mast cell activator compound 48/80 are safe but inefficient systemic adjuvants for gilthead seabream vaccination

Histamine has a key role in the regulation of inflammatory and innate immune responses in vertebrates. Gilthead seabream (Sparus aurata L.), a marine hermaphrodite teleost of great commercial value, was the first fish species shown to possess histamine-containing mast cells (MCs) at mucosal tissues. MCs are highly abundant in the peritoneal exudate of gilthead seabream and compound 48/80 (Co 48/80), often used to promote MC activation and histamine release, is able to promote histamine release from gilthead seabream MCs in vitro and in vivo. The aim of the present study was to analyze the effect of histamine and Co 48/80 on the immune responses of gilthead seabream. For this purpose, histamine and Co 48/80 were intraperitoneally injected alone or combined with 10⁹ heat-killed Vibrio anguillarum cells and their effects on head kidney and peritoneal exudate were analyzed. The results indicated that although histamine and Co 48/80 were both able to alter the percentage of peritoneal exudate and head kidney immune cell types, only Co 48/80 increased reactive oxygen species production by peritoneal leukocytes. In addition, histamine, but not Co 48/80, was able to slightly impair the humoral adaptive immune response, i.e. production of specific IgM to V. anguillarum. Notably, both histamine and Co 48/80 reduced the expression of the gene encoding histamine receptor H2 in peritoneal exudate leukocytes. These results show for the first time in fish that although systemic administration of histamine and Co 48/80 is safe, neither compound can be regarded as an efficient adjuvant for gilthead seabream vaccination.

Epidemiological survey on third molar agenesis and facial pattern among adolescents requiring orthodontic treatment

Background

Material and Methods

Results

Conclusions

Variations in the technique for autologous limbal transplantation

OBJECTIVE

To present the results on the use of a single block limbal autograft, combined with amniotic membrane transplantation and sectoral sequential postoperative epitheliectomy of the conjunctiva in 2 patients with unilateral total limbal stem cell deficiency.

CONCLUSIONS

A single block limbal autograft combined with amniotic membrane transplantation may be sufficient to restore a stable corneal surface, but sometimes sequential sectoral conjunctival epitheliectomy may be required to treat anomalous epithelial remnants.

Activity of a selective inhibitor of nuclear export, selinexor (KPT-330), against AML-initiating cells engrafted into immunosuppressed NSG mice

Currently available combination chemotherapy for acute myeloid leukemia (AML) often fails to result in long-term remissions, emphasizing the need for novel therapeutic strategies. We reasoned that targeted inhibition of a prominent nuclear exporter, XPO1/CRM1, could eradicate self-renewing leukemia-initiating cells (LICs) whose survival depends on timely XPO1-mediated transport of specific protein and RNA cargoes. Using an immunosuppressed mouse model bearing primary patient-derived AML cells, we demonstrate that selinexor (KPT-330), an oral antagonist of XPO1 that is currently in clinical trials, has strong activity against primary AML cells while sparing normal stem and progenitor cells. Importantly, limiting dilution transplantation assays showed that this cytotoxic activity is not limited to the rapidly proliferating bulk population of leukemic cells but extends to the LICs, whose inherent drug resistance and unrestricted self-renewal capacity has been implicated in the difficulty of curing AML patients with conventional chemotherapy alone.

The role of personality traits in self-rated oral health and preferences for different types of flawed smiles

Symmetric, aligned and luminous smiles are usually classified as 'beautiful' and aesthetic. However, smile perception is not strictly governed by standardised rules. Personal traits may influence the perception of non-ideal smiles. We aimed to determine the influence of personality traits in self-rated oral health and satisfaction and in the aesthetic preference for different strategically flawed smiles shown in photographs. Smiles with dark teeth, with uneven teeth, with lip asymmetry and dental asymmetry were ordered from 1 to 4 as a function of the degree of beauty by 548 participants, of which 50·7% were females with a mean age of 41·5 ± 17·6 years (range: 16-89 years). Self-assessment and oral satisfaction were recorded on a Likert scale. Personality was measured by means of the Big Five Inventory (extraversion, agreeableness, conscientiousness, neuroticism and openness), and the Life Orientation Test was used to measure optimism and pessimism. Of the four photographs with imperfect smiles, dental asymmetry was the most highly assessed in 63% of the sample, and the worst was lip asymmetry, in 43·7% of the sample. Some personality traits (above all conscientiousness and openness) were significantly correlated with the position assigned to the photographs with dental and lip asymmetry or with misaligned teeth. The extraversion, agreeableness and openness traits were correlated with the self-perceptions of oral health and aesthetics of the participants. Dental asymmetry seems to be better tolerated than lip asymmetry. Personality traits are weakly but significantly correlated with the aesthetic preference and oral health values, conscientiousness and openness being the most relevant domains in this sense.

Consensus document on allergic conjunctivitis (DECA)

Allergic conjunctivitis (AC) is an inflammatory disease of the conjunctiva caused mainly by an IgE-mediated mechanism. It is the most common type of ocular allergy. Despite being the most benign form of conjunctivitis, AC has a considerable effect on patient quality of life, reduces work productivity, and increases health care costs. No consensus has been reached on its classification, diagnosis, or treatment. Consequently, the literature provides little information on its natural history, epidemiological data are scarce, and it is often difficult to ascertain its true morbidity. The main objective of the Consensus Document on Allergic Conjunctivitis (Documento dE Consenso sobre Conjuntivitis Alérgica [DECA]), which was drafted by an expert panel from the Spanish Society of Allergology and Spanish Society of Ophthalmology, was to reach agreement on basic criteria that could prove useful for both specialists and primary care physicians and facilitate the diagnosis, classification, and treatment of AC. This document is the first of its kind to describe and analyze aspects of AC that could make it possible to control symptoms.

The effects of an electronic order set on vancomycin dosing in the ED

OBJECTIVE

The objective of the study was to assess the impact of a computer physician order entry (CPOE) electronic order set on appropriate vancomycin dosing in the emergency department (ED).

METHODS

We conducted a retrospective study examining ED dosing of vancomycin before and after the implementation of an electronic weight-based vancomycin order set. Preimplementation and postimplementation patient records were analyzed between the dates of June 1st and August 31st 2010 for the pre-CPOE group and January 1st to March 31st 2013 for the post-CPOE group.

STATISTICAL ANALYSIS

χ(2) analysis, Fisher exact test, and t tests were performed with a 2-sided P value <.05 denoting statistical significance, where appropriate.

RESULTS

A total of 597 patients were included in the study, with 220 in the pre-CPOE group and 377 in the post-CPOE group. The use of the electronic order set resulted in a 21.9% increase (P < .05) in appropriate dosing with 67.4% (254/377) of post-CPOE vancomycin doses considered appropriate vs 45.5% (100/220) in the pre-CPOE group. In critically ill patients, there was a 16.3% increase in appropriate dosing with 44.7% (38/85) in the post-CPOE group compared with 28.4% (19/67) in the pre-CPOE group.

CONCLUSION

The implementation of an electronic order set increased the percentage of ED patients receiving appropriate initial vancomycin doses. The impact of increasing compliance to vancomycin guidelines is in accordance with stewardship principles that promote optimization of antimicrobial dosing based on individual patient characteristics. More studies are needed to assess the relationship between appropriate vancomycin loading doses in the ED and therapeutic outcomes.

p53 regulates a non-apoptotic death induced by ROS

DNA damage induced by reactive oxygen species and several chemotherapeutic agents promotes both p53 and poly (ADP-ribose) polymerase (PARP) activation. p53 activation is well known to regulate apoptotic cell death, whereas robust activation of PARP-1 has been shown to promote a necrotic cell death associated with energetic collapse. Here we identify a novel role for p53 in modulating PARP enzymatic activity to regulate necrotic cell death. In mouse embryonic fibroblasts, human colorectal and human breast cancer cell lines, loss of p53 function promotes resistance to necrotic, PARP-mediated cell death. We therefore demonstrate that p53 can regulate both necrotic and apoptotic cell death, mutations or deletions in this tumor-suppressor protein may be selected by cancer cells to provide not only their resistance to apoptosis but also to necrosis, and explain resistance to chemotherapy and radiation even when it kills via non-apoptotic mechanisms.

Influence of Er:YAG and Ti:sapphire laser irradiation on the microtensile bond strength of several adhesives to dentin

The aim of the present study was to evaluate the influence of erbium:yttrium-aluminum-garnet (Er:YAG) and Ti:sapphire laser irradiation on the microtensile bond strength (MTBS) of three different adhesive systems to dentin. Flat dentin surfaces from 27 molars were divided into three groups according to laser irradiation: control, Er:YAG (2,940 nm, 100 μs, 2.7 W, 9 Hz) and Ti:sapphire laser (795 nm, 120 fs, 1 W, 1 kHz). Each group was divided into three subgroups according to the adhesive system used: two-step total-etching adhesive (Adper Scotchbond 1 XT, from now on XT), two-step self-etching adhesive (Clearfil SE Bond, from now on CSE), and all-in-one self-etching adhesive (Optibond All-in-One, from now on OAO). After 24 h of water storage, beams of section at 1 mm(2) were longitudinally cut from the samples. Each beam underwent traction test in an Instron machine. Fifteen polished dentin specimens were used for the surface morphology analysis by scanning electron microscopy (SEM). Failure modes of representative debonded microbars were SEM-assessed. Data were analyzed by ANOVA, chi-square test, and multiple linear regression (p < 0.05). In the control group, XT obtained higher MTBS than that of laser groups that performed equally. CSE showed higher MTBS without laser than that with laser groups, where Er:YAG attained higher MTBS than ultrashort laser. When OAO was used, MTBS values were equal in the three treatments. CSE obtained the highest MTBS regardless of the surface treatment applied. The Er:YAG and ultrashort laser irradiation reduce the bonding effectiveness when a two-step total-etching adhesive or a two-step self-etching adhesive are used and do not affect their effectiveness when an all-in-one self-etching adhesive is applied.

Comparative validity of the OIDP and OHIP-14 in describing the impact of oral health on quality of life in a cross-sectional study performed in Spanish adults

OBJECTIVES

We aimed to compare the utility and validity of two popular socio-dental indicators (OIDP and OHIP-14) for describing the impact of oral conditions on quality of life applied simultaneously.

STUDY DESIGN

We recruited a consecutive sample of 270 healthy Spanish workers visiting the Employment Risk Prevention Centre for a routine medical check-up. OHIP-14 was self-completed before the oral examination and the face to face interview of the OIDP was performed. Both instruments were compared by evaluating its reliability and its validity.

RESULTS AND CONCLUSIONS

The standardised Cronbach alphas for OHIP-14 and OIDP were 0.89 and 0.74 respectively. OIDP showed lower face validity but higher content validity than OHIP-14. Both indicators showed high construct and criterion validity, since individuals perceiving need for dental treatment or having any complaint about their mouth obtained significantly higher total OIDP and OHIP scores than their counterparts. The prevalence of impacts was much higher using the OHIP (80.7%) than the OIDP (27.8%).

The Discovery of Surgical Anesthesia

The suppression of pain during surgical interventions has been a major achievement for humankind. Chronologically, in 1842, William E. Clarke, a chemist in Rochester (NY), provided Elijah Pope with ether for the purposes of tooth extraction. In 1844, in Boston, G.Q. Colton and the dentist Horace Wells used nitrous oxide as an anesthetic for tooth extraction. On the 16th of October, 1846, the American dentist William T.G. Morton became a pioneer within the medical community with respect to anesthesia by inhalation when he used ether as an anesthetic at the Massachusetts General Hospital. In 1847, the Scot James Young Simpson began to use chloroform as an anesthetic for obstetrics in Edinburgh. These events gave rise to several disputes among their users (who are not very well-known today), who strove to claim that they had been the discoverers of surgical anesthesia, with a view to obtaining a series of patents and state sinecures. This article attempts to clarify certain discrepancies about the authorship of surgical anesthesia. The evidence suggests that surgical anesthesia first began to be applied in the field of dentistry.

[SERV clinical practice guidelines: management of retinal vein occlusion. Sociedad Española de Retina y Vitreo]

PURPOSE

A guidelines for the management of retinal vein occlusion is presented. This is necessary because at this moment several therapeutic alternatives have been developed although their role is not yet sufficiently defined.

METHODS

Review of the literature for evidence published up to date. Relevant literature was identified and the level of evidence graded. Evidence was then assessed for consistency, applicability and clinical impact. The information was contrasted with those guides published in other countries.

RESULTS

Taking into account the different options of treatment that are currently used, several modes of action are suggested. The role of the various complementary examinations are discussed and it is recommended that criteria for the treatment are based on clinical, angiographic, and tomographic findings.

CONCLUSIONS

Although there is no overall consensus, these guidelines promote a good standard of clinical practise and provide an update of the management of retinal vein occlusion.

[Assessment of the efficiency of the clinical management of neuropathic pain in specialist clinics compared to general clinics in neurology health care units in Spain]

OBJECTIVES

To analyse the cost-consequences of chronic neuropathic pain (NeP) outpatients care comparing management in general clinics (GC) versus specialised pain clinics (SPC) in neurology settings in Spain.

METHODS

A 6-month retrospective, cross-sectional, comparative observational study including NeP subjects was designed. Sociodemographics and clinical characteristics of subjects along with pain-related healthcare and non healthcare resources utilization were recorded. Lost-work-days equivalent missed as a consequence of pain were also collected to compute indirect costs. Costs to society were calculated in euros for the year 2008. Severity and interference of pain were used for the main effectiveness evaluation.

RESULTS

A total of 234 patients (53% in SPC), 56.8% women, and 59.3+/-14.7 years were included. Patients were allocated according to usual administrative procedures in each participant centre, consecutively and independently of the diagnosis and clinical status of patients. Yearly indirect costs were euro1,299+/-2,804 in SPC compared to euro1,483+/-3,452 in GC (p=0.660), while annual direct costs were, euro2,911+/-3,335 and euro3,563+/-4,797, respectively (p=0.239), with total costs of euro4,210+/-4,654 and euro5,060+/-6,250, respectively (p=0.249). Mean pain severity at the time of evaluation was 3.8+/-2.3 in subjects in SPC vs. 5.2+/-2 in GC (p<0.001), while the average interference of pain on daily activities were 3.3+/-2 and 4.7+/-2.5, respectively (p<0.001).

CONCLUSIONS

In neurology settings in Spain, the outpatient clinical management of chronic NeP in SPC was a dominant alternative compared with GC healthcare, since it has shown better patients healthcare outcomes with less severity and interference of pain on daily activities, while maintaining a similar level of costs. These results could help health decision makers when planning the use of health care resources.

[Aniridia, congenital glaucoma and white corneas in a newborn baby]

CASE REPORT

We present the case of a newborn baby in whom we observed aniridia, congenital glaucoma and edematous corneas, without clearance of the cornea after glaucoma surgery, and in whom a keratoplasty was considered. The patient had no evidence of systemic diseases and no deletion of chromosome 11.

DISCUSSION

It is important to perform a thorough ophthalmological and systemic exploration in newborn patients with aniridia due to other diseases that can be associated with it. We present the unusual case in which aniridia, congenital glaucoma and white corneas coexisted in a newborn baby. To our knowledge, such cases have only been reported twice before in the literature (Arch Soc Esp Oftalmol 2009; 84: 573-576).