The association between vitamin D binding protein levels and periodontal status: A systematic review

BACKGROUND AND OBJECTIVES

Vitamin D binding protein (DBP) is biosynthesised in the liver and is predominantly expressed in serum. Its primary role centres on facilitating the systemic transportation of vitamin D and its metabolites, notably 25-hydroxyvitamin D, to specific target tissues where vitamin D exerts its biological functions. Due to the paucity of studies, it is unclear whether there is an association between DBP and periodontal status and thus its potential use as a diagnostic biomarker. Therefore, the aim of the systematic review is to investigate the association between DBP in periodontal disease.

METHODS

Two independent reviewers (YD and RG) performed a systematic literature search of English publications using several databases including MEDLINE (OVID interface, 1946 onwards), EMBASE (OVID interface, 1974 onwards), and Global Health (OVID interface, 1973 onwards). This search strategy enabled the identification of relevant publications and the development of a comprehensive library of studies. Studies were included based on previously agreed eligibility criteria. Of the eight studies included as part of this systematic review, seven were case-control studies and one was a cross-sectional study. The quality assessment was based on the Newcastle-Ottawa Scale (NOS) for case-control studies and the modified NOS for the cross-sectional study.

RESULTS

The NOS quality assessment was 'favorable' for 6 included case control studies; and 'fair' for one study. The modified NOS quality assessment for the single cross-sectional study demonstrated a medium risk of bias. The results of the majority of the included studies indicated a statistically significant higher concentration of DBP levels in individuals with periodontitis in comparison to those who were periodontally healthy. This trend held true irrespective of the sampling method employed for the assessment of DBP concentration.

CONCLUSION

The results summarised in this systematic review indicate a positive association between DBP and periodontitis. Nonetheless, there is a need for longitudinal, prospective trials, to confirm the use of DBP as a potential biomarker for the diagnosis of periodontitis.

Assessment of the quality of oral biopsy procedure videos shared on YouTube

OBJECTIVE

The aim of this study was to assess the quality of free-to-access videos on oral biopsy procedures on the YouTube platform.

MATERIALS AND METHODS

We conducted a search on YouTube using the term "oral biopsy" and selected the first 100 videos in order of relevance. The following exclusion criteria were applied: language other than English, videos that did not cover oral biopsy techniques, videos on nonhuman specimens, postoperative instructions, personal experiences, exfoliative cytology, or "brush biopsy." Forty-seven selected videos were classified based on their duration, country of origin, date of upload to the system, author, information source and number of views, and likes and dislikes. Video quality was analyzed using DISCERN, the Global Quality Scale (GQS), and the Video Information and Quality Index (VIQI).

RESULTS

The majority (78.7%) of analyzed videos were uploaded by dentists, originating from India (48.9%), with a mean duration of 11.8 min (SD, 20.4), with 104.5 likes (SD, 186.4) and 7.1 dislikes (SD, 10.55). The mean values for DISCERN, GQS, and VIQI were 1.3 (SD, 0.52), 2.1 (SD, 1.04), and 9.62 (SD, 1.69), respectively.

CONCLUSION

The majority of videos on oral biopsy published on YouTube are of low quality.

An observational retrospective study of odontogenic cyst´s and tumours over an 18-year period in a Portuguese population according to the new WHO Head and Neck Tumour classification

Background

Odontogenic cysts and tumours of the jaws represent one of the most prevalent groups of oral-maxillofacial lesions. We aimed to evaluate the clinical and pathological characteristics of a cohort of odontogenic cysts (OC) and odontogenic tumours (OT) of the jaws in a Portuguese population.

Material and Methods

This observational retrospective study analysed patients diagnosed with either an OC or OT of the jaws at a central hospital of Oporto, Portugal, between 1988 and 2006. Data collected from patients’ files included demographic, clinical, radiological and histopathological information. Recurrence was evaluated using univariate and multivariate analysis.

Results

The sample consisted of 397 patients, 231 males (58.2%) and 166 females (41.8%), with a mean-age of 36.7±17 years. Twenty-seven patients (6.8%) presented with more than one lesion providing a total of 433 lesions. There were 396 (91.5%) OC, mostly represented by radicular cysts (n=257;59.4%), dentigerous cysts (n=79;18.2%), or odontogenic keratocysts (n=50;11.5%). There were 37 (8.5%) OT, mostly represented by ameloblastomas (n=16;3.7%), and odontomas (n=9;2.1%). The most common initial clinical manifestation was swelling (n=224;51.7%). Recurrence was observed in 30 cases (6.9%), mostly in ameloblastomas (n=6;37.5%) and odontogenic keratocysts (n=12;24%). In the multivariate analysis the diagnosis classification of the lesion was the only independent and significant variable related with the recurrence (P=0.04).

Conclusions

Radicular cysts were the most commonly occurring type of OC and ameloblastomas the most commonly occurring OT. Amelobastomas and odontogenic keratocysts were the lesions with the highest rates of recurrence. This large sample provides useful information about the frequency profile and characteristics of OC and OT over a period of 18 years, allowing valuable comparison with data from other countries.

Key words:Odontogenic cysts and tumours, radicular cyst, dentigerous cyst, odontogenic keratocyst, ameloblastoma, recurrence.

Mental health in pandemic times - a review

Introduction

Any outbreak of pandemic dimension will most likely produce a serious amount of distress and prejudice to anyone, in particular when it comes to mental health. The pandemic impact in primary care and in the psychiatric emergency department are some of the topics discussed in this review.

Objectives

It aims to review, evaluate and reflect over the impact of a deadly coronavirus pandemic on mental health, as well as presenting possible long-term challenges and potential ways to approach it.

Methods

A non-systematic literary review was performed on the Pubmed, PsycInfo and Cochrane databases using the key words “covid-19”, “psychiatry”, “self-isolation” and “telepsychiatry”.

Results

Globally and, as expected, there has been a general increase in need for psychiatric assessment and treatment due to the COVID-19 pandemic.

Conclusions

The role of psychiatry has faced quite some challenges in such a short period of time: the rise of telepsychiatry; the management of patients with both a psychiatric disorder and an infection with the new coronavirus and the need to provide an adequate psychiatric assistance in the emergency room has become the new normal.

Transoral robotic surgery vs open surgery in head and neck cancer. A systematic review of the literature

Background

TORS has become one of the latest surgical alternatives in the treatment of oropharynx squamous cell carcinomas (OPSCC) and has become increasingly accepted by surgeons as a treatment option. Surgical robots were designed for various purposes, such as allowing remote telesurgery, and eliminating human factors like trembling. The study aimed to compare systematic review of the available literature in order to evaluate the safety and efficacy of Transoral Robotic Surgery (TORS) compared with open surgery.

Material and Methods

We performed a systematic review of the available literature in order to evaluate the safety and effectiveness of TORS compared with open surgery. We compared TORS and open surgery based on 16 outcomes divided in to 3 groups: intra-operative complications, post-operative complications, and functional and oncologic outcomes. An electronic search of observational studies was carried out using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Oral Health Group Trials Register, and Scielo. Data analysis was carried out in accordance to Preferred Reporting Items for Systematic Reviews and Metanalysis (PRISMA) and the quality of the studies were evaluated using the Newcastle-Ottawa Scale. No language restrictions were imposed.

Results

From the 4 studies identified (Newcastle-Ottawa Scale mean score 6.5), 371 patients were revised (186 patients were treated with TORS and 185 with conventional surgery). Overall, TORS, when compared with open surgery, appears to have better functional results (less hospital time, decannulation) and fewer intraoperative and post-operative complications. There is no significant difference when assessing the oncological outcomes (positive margins, survival rate) when comparing both techniques.

Conclusions

TORS has an overall better functional outcome, and less intraoperative and postoperative complications with no difference in positive margins and survival rate when compared with conventional therapy.

Key words:Transoral Robotic Surgery, TORS, open surgery, conventional surgery, head and neck cancer, oral cancer.

IMMPACT-recommended outcome measures and tools of assessment in burning mouth syndrome RCTs: an international Delphi survey protocol

Background

A core outcome set (COS) represents the agreed minimum set of domains and measurement instruments that should be measured and reported in any clinical trial for a given condition. In BMS randomized controlled trials (RCTs), the outcomes identified in the existing literature regarding the efficacy of therapeutic interventions are numerous and diverse. Although the standardized IMMPACT core outcome domains has been developed for measurement of outcomes in chronic pain RCTs, no BMS-specific COS have been adopted and validated. With the evolving landscape of BMS management end points and the development of new therapies, a consensus on a COS for use in future BMS trials is paramount to reduce heterogeneity in outcome reporting. The aim of this study was to reach a consensus for adopting the standardized Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) outcome domains, and their tools of assessment, for burning mouth syndrome (BMS) clinical trials and clinical practice.

Methods

A BMS-specific COS will be developed using the method recommended by the Core Outcome Measures in Effective Trials (COMET) initiative (Registration: http://www.comet-initiative.org/studies/details/1357). Selection of questionnaire outcome measures was informed by the IMMPACT consensus and previous systematic review of RCTs in BMS conducted by the consortium. An international group of clinicians and researchers will be invited to participate in several rounds of a Delphi survey. A consensus meeting will be held with the objective of ratifying the outcomes for inclusion in the COS. A finalized COS explanatory document will be drafted, including all outcomes and measurements as determined by the Delphi rounds and consensus meeting.

Discussion

A COS for the management of BMS will improve the quality of future RCTs, reduce outcome reporting heterogeneity, and facilitate more vigorous data synthesis of management interventions for systematic reviews and meta-analysis. This would ensure enhanced quality evidence for clinical management of the condition.

A cross-sectional study of confidence in minor surgical skills amongst junior dentists

INTRODUCTION

To work in the National Health Service (NHS) as a dentist, the practitioner needs to be on the UK dental "performer's list". To apply for access to this list and work as a General Dental Practitioner (GDP), dentists must be qualified from the European Economic Area (EEA) or, those trained in the UK, must undertake Dental Foundation Training (DFT). Dentists interested in further taught learning or pursuing specialist training must continue working as "Dental Core Trainees" (DCTs). Most of these jobs are available in Oral and Maxillofacial Surgery (OMFS) Units and require dentists to undertake unsupervised surgical procedures. It is currently estimated that over 400 "junior dentists" undertake DCT a year. It is the aim of this study to ascertain whether confidence in simple surgical procedures improves when compared to GDPs of similar experience.

METHODS

One hundred and two junior dentists, 34 DFTs, 20 DCT1s, 21 DCT2s and 27 second and third year post-DFT GDPs all working across the Midlands, UK, had Likert scale responses about confidence in 14 minor surgical skills assessed. Results were analysed to ascertain whether gender, year group and number of extractions had any effect on confidence.

CONCLUSIONS

We conclude that confidence in minor surgical procedures improves significantly when undertaking DCT OMFS posts, with the most significant improvement in confidence occurring within the first 6 months. Dental Core Trainees become significantly more confident in their surgical ability within the first 6 months when compared to GDPs with longer postgraduate experience.

Meta-analytic study of organic acids as an alternative performance-enhancing feed additive to antibiotics for broiler chickens

The effect of organic acids as an alternative to antibiotics on the performance of broiler chickens was evaluated by meta-analysis, identifying and quantifying the main factors that influence results. A total of 51,960 broilers from 121 articles published between 1991 and 2016 were used. Interactions of additives [non-supplemented group (control), organic acids, and growth promoter antibiotics] with microbial challenge (with or without inoculation of pathogenic microorganisms) were studied on performance variables. Moreover, the effects of organic acids, used individually or in blends, were evaluated. Relative values of average daily gain (ADG) and average daily feed intake (ADFI) were obtained in relation to control: ΔADG and ΔADFI, respectively. Analysis of variance-covariance revealed lower ADG with organic acids when compared to antibiotics (P < 0.05). There was a significant interaction between the additives and the challenge on feed conversion ratio (FCR) (P < 0.01) and on viability (P < 0.05). Without challenge, organic acids improved broilers’ FCR (P < 0.01), presenting results similar to antibiotics (P > 0.05). Under challenge, the organic acids were again effective on FCR (−5.67% in relation to control, P < 0.05), but they did not match antibiotics (−13.40% in relation to control, P < 0.01). Viability was improved only under challenge conditions, and only by antibiotics (+4.39% in relation to control, P < 0.05). ADG (P < 0.05) and FCR (P < 0.01) were increased by blends of organic acids, but not by the organic acids used alone (P > 0.05). ADFI and production factor were not influenced by the treatments (P > 0.05). ΔADFI of organic-acid supplemented group showed a linear influence on ΔADG, which increases 0.64% at every 1% increase in ΔADFI. In conclusion, organic acids can be utilized as performance enhancing, but the results are lower than those found with antibiotics, particularly under microbial challenge. The blends of organic acids provide better results than the utilization of one organic acid alone.

Prevalence of calcifications in soft tissues visible on a dental pantomogram: A retrospective analysis

OBJECTIVES

To determine the frequency and spectrum of soft tissues calcifications identified on Dental Pantomograms (DPT) at a University Dental Clinic in the northern region of Portugal and to compare the data obtained with those published in the literature.

METHODS

We conducted a 3-year descriptive analysis (2012-2014) of DPT calcifications within soft tissues at the University Clinic (CESPU), in Oporto, Portugal. Information on gender, age, location of the lesions and the radiographic diagnosis were analysed. DPTs were interpreted by two examiners (Kappa test 0.8). Data were entered into a database and analysed with Chi-square and Fisher exact tests. Statistical analysis was performed using the Kolmogorov-Smirnov and Shapiro-Wilk test.

RESULTS

2375 DPTs were analysed, with 468 calcifications observed in the radiographs of 420 individuals. Calcifications of the stylohyoid and stylomandibular ligament were most common, with atheroma, sialoliths, tonsilloliths rhinoliths and antroliths also identified. A statistically significant relationship was observed between the presence of calcifications of the stylohyoid and stylomandibular ligaments, atheromatous calcifications in the carotid artery and tonsilloliths in individuals older than 40.

CONCLUSIONS

This is the largest sample analysis ever done in Portugal, providing useful information about the incidence and distribution of soft tissue calcifications identifiable on DPTs, allowing valuable comparison with other countries.

ADVANCES IN KNOWLEDGE

Despite mostly being incidental findings, panoramic radiography can be the first relevant test that aids dental practitioners in the process of requesting other imaging techniques or forwarding to the correct specialty.

Independent estimates of marine population connectivity are more concordant when accounting for uncertainties in larval origins

Marine larval dispersal is a complex biophysical process that depends on the effects of species biology and oceanography, leading to logistical difficulties in estimating connectivity among populations of marine animals with biphasic life cycles. To address this challenge, the application of multiple methodological approaches has been advocated, in order to increase confidence in estimates of population connectivity. However, studies seldom account for sources of uncertainty associated with each method, which undermines a direct comparative approach. In the present study we explicitly account for the statistical uncertainty in observed connectivity matrices derived from elemental chemistry of larval mussel shells, and compare these to predictions from a biophysical model of dispersal. To do this we manipulate the observed connectivity matrix by applying different confidence levels to the assignment of recruits to source populations, while concurrently modelling the intrinsic misclassification rate of larvae to known sources. We demonstrate that the correlation between the observed and modelled matrices increases as the number of observed recruits classified as unknowns approximates the observed larval misclassification rate. Using this approach, we show that unprecedented levels of concordance in connectivity estimates (r = 0.96) can be achieved, and at spatial scales (20-40 km) that are ecologically relevant.

Coffee is protective against oral and pharyngeal cancer: A systematic review and meta-analysis

OBJECTIVES

Coffee is one of the most popular and consumable drinks worldwide. However, there are conflicting results on the influence of this drink in oral and pharyngeal cancer risk. To clarify this, we aimed to systemically review and carry out a meta-analysis of the relevant literature on the association between coffee and oral and pharyngeal cancer.

STUDY DESIGN

We carried out an electronic search of publications up to August 2016 from PubMed, National Library of Medicines Medline, Embase, Science Direct and the Cochrane Central Register. The Newcastle-Ottawa scale was used to address the quality of the studies a meta-analysis was carried out using random-effects models.

RESULTS

From the 22,515 entries identified in the search, 13 case-control and 4 cohort studies were selected. With regards to quality on the Newcastle-Ottawa scale, an overall value of 6.06 was obtained. The analysis for oral and pharyngeal cancer grouped together indicated a pooled OR of .69 (95% CI of .57-.84; p<.001) for high versus low coffee consumption with a moderate heterogeneity (I2: 50.3%; p=.009). Regarding studies on oral cavity cancers we observed a pooled OR of 0.82; 95% CI =.58-1.16; p=.257) and for pharyngeal cancers a pooled OR of .72 (95% CI of 0.54-.95; p=.019). There was no significant publication bias.

CONCLUSION

The results show an inverse association between high coffee consumption and the risk of oral and pharyngeal cancers, which indicates that coffee may have a protective role against these cancers. Further larger prospective observational cohort studies are needed to address any effect of other possible co-factors.

Effects of lipid sources, lysophospholipids and organic acids in maize-based broiler diets on nutrient balance, liver concentration of fat-soluble vitamins, jejunal microbiota and performance

Three experiments with a 2 × 2 × 2 factorial arrangement were conducted to evaluate maize-based diets for broilers containing different lipid sources [soybean oil (S) or beef tallow (T)] supplemented with or without lysophospholipids and organic acids on nutrient balance (Experiment I, evaluation period of 10-14 d), on liver concentration of fat-soluble vitamins, on jejunal microbiota (Experiment II, sampling at d 14) and on performance (Experiment III, accumulated periods of 1-14, 1-21 and 1-42 d). A total of 1344 male chicks were used. In each experiment, the birds were allotted in a completely randomised design with 8 replications. The lysophospholipids were mainly composed of lysolecithins and the organic acids blend was constituted by lactic (40%), acetic (7%) and butyric acids (1%). An interaction between lipid sources and lysophospholipids was observed on faecal apparent digestibility of lipid (ADL), which improved with lysophospholipids addition in T diets. Broilers fed on S had higher ADL and faecal apparent digestibility of nitrogen-corrected gross energy (ADGE_N). It was not possible to demonstrate a significant treatment effect on the liver concentration of vitamins A and E, even with the differences in fatty acid profile between S and T. Enterobacteria values were below the detection threshold. Lysophospholipid supplementation reduced gram-positive cocci in T-fed birds. S diets promoted lower total anaerobe counts compared with T diets, independent of additives. S diets increased BW gain and feed:gain ratio in all evaluation periods. Lysophospholipids and organic acids improved feed:gain ratio at 1-21 d in T diets. Furthermore, main effects were observed for lysophospholipids and organic acids at 1-42 d, which increased BW gain and improved feed:gain ratio, respectively. No positive interactions between additives were found.

The association between the 4G/5G polymorphism in the promoter of the plasminogen activator inhibitor-1 gene and deep venous thrombosis in young people

Objective: To evaluate the association between the 4G/5G polymorphism in the promoter of the plasminogen activator inhibitor-1 (PAI-1) gene and deep venous thrombosis (DVT) in young people.

Methods: Prevalence of the 4G/5G polymorphism was investigated using DNA analysis in a population of 81 consecutive and unrelated patients with an objectively documented first episode of DVT under 40 years old and in a control group of 88 healthy subjects.

Results: The frequency of genotypes among patients was 0.27 4G/4G, 0.49 4G/5G and 0.23 5G/5G, corresponding to a frequency of 0.52 for the 4G allele. In the control group the results were, respectively, 0.24, 0.44 and 0.32, corresponding to a frequency of 0.46 for the 4G allele. The odds ratio (OR) for homozygous 4G genotype was 1.5 (95% confidence interval: 0.7–3.6), which was not statistically significant ( P = 0.51).

Conclusion: In this study, the 4G/5G polymorphism in the promoter of the PAI-1 gene, including the homozygous 4G genotype, was not associated with a significantly increased risk of DVT in young people.

Effect of lipid sources and inclusion levels in diets for broiler chickens

This research aimed to evaluate the interactions and effects of 2 and 4% addition levels of poultry slaughterhouse fat (chicken tallow) and soybean oil in diets for broiler chickens. Two experiments were carried out using one-day-old male Cobb chicks in an entirely random design with a 2x2 factorial scheme. In the first experiment, 560 chicks were used to evaluate performance and carcass characteristics. In the second experiment, 100 chicks were used to determine the nutrient digestibility, dietary energy utilization and the lipase and amylase pancreatic activity. There was no interaction between the fat sources and the addition levels for any of the analyzed variables, except for the digestibility coefficient of dry matter (DCDM), which was higher in diets added with 2% soybean oil when compared to chicken tallow. The addition of 4% fat in the diet, regardless of fat source, improved the digestibility coefficient of ethereal extract (DCEE) and increased weight gain and feed intake. Moreover, in the initial phase, the addition of 4% fat to the diet increased lipase activity when compared to diets with 2% addition, and a positive correlation between DCEE and pancreatic lipase activity was observed. In conclusion, there is no interaction between fat sources and addition levels, except for DCDM. Carcass characteristics are not influenced by any of the studied factors. The addition of 4% fat increases pancreatic lipase activity and improves DCEE, resulting in greater weight gain, regardless of the tested fat source, making chicken tallow a great alternative to soybean oil.

Parâmetros ósseos de frangos de corte alimentados com rações contendo fitase e baixos níveis de fósforo disponível e proteína bruta

Foram utilizados 504 pintos de linhagem comercial (Ag Ross 308) para frangos de corte de um dia de idade, distribuídos em 12 tratamentos com seis repetições. O delineamento experimental utilizado foi de blocos ao acaso em esquema fatorial 2x2x3, com dois níveis de fósforo disponível (0,45 e 0,34%), dois níveis de fitase (0 e 1200 FTU/kg) e três níveis de proteína bruta (22,5; 20,5 e 18,5%). A porcentagem de cálcio e fósforo nas tíbias foi influenciada significativamente pelos níveis de proteína e de fósforo na dieta com o uso da fitase. Os teores de matéria mineral nas tíbias apresentaram efeito linear com o uso da enzima e efeito quadrático com a ausência dela, apresentando maior valor com o nível de 22,5% de proteína na dieta. Já com os maiores níveis de fósforo houve efeito linear entre os níveis de proteína bruta na dieta e os pesos da matéria mineral nas tíbias, ou seja, quanto maior o nível de proteína, menor o peso da matéria mineral.

Lisina digestível para frangos de corte machos entre 12 e 22 dias de idade

Avaliou-se nível de lisina digestível para 1050 frangos de corte dos 12 aos 22 dias de idade. O delineamento experimental foi inteiramente ao acaso, com cinco tratamentos, sete repetições e 30 aves por unidade experimental. Os tratamentos foram: 1,05; 1,10; 1,15; 1,20 e 1,25% de lisina digestível. Avaliaram-se ganho de peso, consumo de ração, conversão alimentar, composição e deposição de nutrientes corporais. Foram constatados efeitos quadráticos de lisina digestível no consumo de ração e resposta linear ascendente no peso da carcaça. Na composição química da carcaça, houve resposta quadrática do nível de lisina na concentração de proteína. As taxas de deposição proteica, deposição de água, da carcaça e do corpo total tiveram aumento linear em resposta ao acréscimo de lisina na dieta. O aumento da concentração de lisina, todavia, coincidiu com a redução da matéria mineral nas vísceras e sangue e no corpo total. Considerado o desempenho, o nível 1,1% de lisina digestível atendeu às necessidades do frango de corte entre o 12º e o 22º dia de idade. Consideradas a composição química e as taxas de deposição dos nutrientes corporais, a demanda pelo aminoácido digestível torna-se igual ou maior que 1,25%

Effects of prolonged oral administration of aflatoxin B1 and fumonisin B1 in broiler chickens

The effects of prolonged oral administration of aflatoxin B1 (AFB1) and fumonisin B1 (FB1) mycotoxins were evaluated in broiler chickens from 21 to 42 d of age. A total of 192 birds were housed in experimental batteries and assigned to 32 cages, 6 birds per cage. The following treatments were applied: 1) 0 mycotoxins (control), 2) 10 mg of FB1, 3) 50 microg of AFB1, 4) 50 microg of AFB1 + 10 mg of FB1, 5) 350 microg of AFB1, 6) 350 microg of AFB1 + 10 mg of FB1, 7) 2,450 microg of AFB1, 8) 2,450 microg of AFB1 + 10 mg of FB1/kg of feed. Each treatment consisted of 4 replicates of 6 birds each. At the end of the trial, blood samples from 12 birds per treatment were collected, and the birds were necropsied. Compared with controls, the percentage of heterophils was lower (P < 0.05) in birds from groups receiving 50 microg of AFB1/kg + 10 mg of FB1/ kg and 2450 microg of AFB1/kg alone or in combination with FB1. A higher percentage of lymphocytes (P < 0.05) was observed in birds fed 50 microg of AFB1/kg + 10 mg of FB1/ kg, 350 microg of AFB1/kg, and 2,450 microg of AFB1/kg. A decrease in plasma albumin was observed only in birds fed 2,450 microg of AFB1/kg + 10 mg of FB1/kg. The liver of AFB1-treated birds had focal areas of necrosis and inflammatory infiltrates. In birds fed rations containing only 10 mg of FB1/kg, bile duct hyperplasia with fibrosis and a mononuclear infiltrate accompanied by trabecular derangement were observed. In contrast, in treatments in which FB1 was administered in combination, hepatic vacuolar degeneration was observed, and renal tissue presented corpuscles with increased cellular agglomeration, characterizing glomerulonephritis, and a clearly visible tubular epithelium with areas of degeneration and necrosis. The FB1 residues were detected in liver and in excreta of all FB1-treated groups, at levels that ranged from 0.013 to 0.051 mg/kg and from 1.19 to 2.79 mg/kg, respectively. Results indicated that FB1 and AFB1, singly or in combination at the levels evaluated, do not change markedly the hematological and serological parameters of broiler chickens, but may cause relevant lesions in liver and in kidneys.

Anger, hostility and aggression in the first days of acute stroke

In acute stroke patients, anger can disturb management and rehabilitation and creates a stressful situation for family, health-care providers and other patients. We aim to describe the presence of anger and its association with demographic, clinical, psychiatric, lesion variables and functional outcome in acute stroke patients. We screened anger prospectively in 202 consecutive acute stroke patients (< or =4 days) using eight items from three psychiatric scales (Catastrophic Reaction Scale, Mania Rating Scale and Comprehensive Psychopathological Rating Scale). Anger was present if the patient scored in at least one item. Anger was detected in 71 (35%) patients and 26 of these were severely angry (> or =4 points). There was no association between anger and the considered variables. Analysis of the items extracted two factors: (i) the emotional-cognitive and (ii) the behavioural components of anger. These components were independent of each other in 26 patients. In 38 patients we found a dissociation between clinical observation and patients' subjective expression. Anger was frequent in acute stroke patients. Anger was probably triggered by the brain lesion, which interfered with the emotional control. The lack of an association with clinical and imaging variables suggests a contribution of psychological/psychosocial dimensions.

Combined Factor V Leiden (R506Q) and prothrombin G20210A genotyping in young patients presenting with deep venous thrombosis

Objective: To evaluate the association between the Factor V Leiden (FV R506Q) and prothrombin gene (FII G20210A) mutations and deep venous thrombosis (DVT) in young people.

Methods: Blood samples were drawn from 199 subjects: 100 healthy controls and 99 unselected patients, with an objectively documented first episode of DVT under 40 years old. DNA analysis was performed using the polymerase chain reaction.

Results: The mean age in the patient cohort was 27 years (range 16–40) and 68 (68.7%) were women. Patient prevalences were 20.6% and 10.1% for FV R506Q and FII G20210A, respectively. In the control group, carrier frequencies were 2% and 5%, respectively. We found an increased overall relative risk of DVT with statistical significance for FV R506Q carriers (OR: 12.8; 95% CI: 2.9–56.7; P < 0.001), but not for FII G20210A mutation (OR: 2.1; 95% CI: 0.7–6.5; P = 0.19).

Conclusions: Our results suggest a possible increase in DVT risk for the young G20210A allele carriers, which can be more expressed in the presence of a circumstantial risk factor. There is extremely strong evidence that the Factor V Leiden mutation is an important risk factor in the development of a first episode of DVT in young people.

Genetic Polymorphisms and Risk of Recurrent Deep Venous Thrombosis in Young People: Prospective Cohort Study

OBJECTIVE

To determine the incidence of deep venous thrombosis (DVT) recurrence in young people, and its association with some genetic polymorphisms (FV G1691A, FII G20210A, MTHFR C677T, PAI-1 4G/5G).

DESIGN

Prospective cohort study.

METHODS

A database was established prospectively to follow-up a cohort of unselected patients who had had a first episode of objectively proven DVT under the age of 40 years. All patients had DNA analysis for heritable thrombophilia. We excluded patients with deficiency of antithrombin, protein C or protein S, malignant disease, antiphospholipid syndrome, or a requirement for long-term antithrombotic treatment. The end-point was objective evidence of symptomatic DVT recurrence.

RESULTS

Eighty-seven patients were enrolled in the study. Mean duration of follow-up was 4.07 years. At 2 years, the cumulative recurrence rate was 19.3%. The risk of risk was not related to presence or absence of laboratory evidence of genetic polymorphisms: FV G1619A (HR 1.26 [95%CI: 0.64-2.46]; p = 0.51), FII G20210A (HR 0.81 [95%CI: 0.35-1.89]; p = 0.62), MTHFR C677T (HR 1.26 [95%CI: 0.56-2.81]; p = 0.58), PAI-1 4G/5G (0.84 [95%CI: 0.35-2.05]; p = 0.71).

CONCLUSION

In this study, the risk of recurrent deep venous thrombosis in young people was not related with the presence of FV G1691A, FII G20210A, MTHFR C677T or PAI-1 4G/5G polymorphisms.

Effect of dietary fumonisin B1 on laying Japanese quail

1. A 28-d experiment was conducted to evaluate the effects of fumonisin B1 (FB1) on egg production and egg quality of young laying Japanese quail fed on fumonisin-contaminated rations. 2. To this end, 128 7-week-old birds were randomly distributed into 4 experimental groups (32 birds per group) and given rations containing 0 (control), 10, 50 and 250mg FB1/kg feed. Each treatment consisted of 4 replicates of 8 quail. Egg production and egg weight were checked daily. Feed consumption and feed conversion were determined weekly. Eggs laid on the last day of each 7-d period were collected and subjected to individual analysis for specific gravity, Haugh units and percentage eggshell. 3. Compared with controls, quail given > or = 50 mg FB1/kg had reduced feed intake and lower body weight gain. Feed conversion was reduced only in birds given 250 mg FB1/kg. 4. Mean egg production and egg weight were lower in birds given 250mg FB1/kg. Eggshell weight was reduced in birds given > or =50mg FB1/kg. However, mean specific gravity, Haugh units and percentage eggshell were not affected by FB1. 5. No histopathological changes were observed in liver, kidney or heart samples from any treatment group. 6. The results indicated that exposure to FB1 at concentrations > or = 50 mg/kg could adversely affect quail performance, emphasising the importance of controlling fumonisin contamination of quail rations.

Effects of prolonged administration of aflatoxin B1 and fumonisin B1 in laying Japanese quail

In the present study, 288 8-wk-old Japanese quail were randomly distributed into 6 experimental groups (48 birds per group) and fed the following diets for 140 d: 1) 0 (control); 2) 10 mg of fumonisin B1 (FB1); 3) 50 microg of aflatoxin B1 (AFB1); 4) 50 microg of AFB1 + 10 mg of FB1; 5) 200 microg of AFB1; and 6) 200 microg of AFB1 + 10 mg of FB1/kg of feed. Each treatment consisted of 4 replicates of 12 quail. Egg production and individual egg weight were checked daily. Feed intake and feed conversion were determined weekly. Results showed that by the end of the fifth cycle, average egg weight was lower (P < 0.05) in groups fed 10 mg of FB1/kg, 50 microg of AFB1/kg, 200 microg of AFB1/kg, and 10 mg of FB1 + 50 microg of AFB1/kg of feed. Egg production decreased (P < 0.05) in birds fed 10 mg of FB1/kg by the third, fourth, and fifth cycles. Feed intake was lower (P < 0.05) in birds fed 10 mg of FB1/kg by the fourth and fifth cycles, and in birds fed 50 and 200 microg of AFB1/kg in the fifth cycle. Birds fed 10 mg of FB1 + 50 microg of AFB1/kg consumed less feed (P < 0.05) in the first, second, and fifth cycles. Results indicated that prolonged administration of FB1 and AFB1, singly or in combination at the levels evaluated, may cause economic losses to quail egg producers.

Delirium in acute stroke: a preliminary study of the role of anticholinergic medications

The pathogenesis of delirium in acute stroke is incompletely understood. The use of medications with anticholinergic (ACH) activity is associated with an increased frequency of delirium. We hypothesized that the intake of medications with ACH activity is associated with delirium in acute stroke patients. Delirium was assessed using the DSM-IV-TR criteria and the Delirium Rating Scale, in a sample of consecutive patients with an acute (< or =4 days) cerebral infarct or intracerebral haemorrhage (ICH). We performed a gender and age matched case-control study. Twenty-two delirious stroke patients (cases) and 52 non-delirious patients (controls) were compared concerning the intake of ACH medications (i) before stroke, (ii) during hospitalization but before the assessment. The variables associated with delirium on bivariate analysis were entered in a stepwise logistic regression analysis. The final regression model (Nagelkerke R2 = 0.65) retained non-neuroleptics ACH medication during hospitalization (OR = 24.4; 95% CI = 2.18-250), medical complications (OR = 20.8; 95% CI = 3.46-125), ACH medication taken before stroke (OR = 17.5; 95% CI = 1.00-333.3) and ICH (OR = 16.9; 95% CI = 2.73-100) as independent predictors of delirium. This preliminary result indicates that drugs with subtle ACH activity play a role in the pathogeneses of delirium in acute stroke. Medication with ACH activity should be avoided in acute stroke patients.

Effect of low levels of dietary aflatoxin B1 on laying japanese quail

In the present study, 256 7-wk-old Japanese quail were randomly distributed into four experimental groups (64 birds per group) and given rations containing 0 (controls), 25, 50, or 100 (g aflatoxin B, (AFB1)/kg feed for 168 d. Each treatment consisted of four replicates of 16 quail. Egg production and individual egg weight were checked daily. Feed consumption and feed use were determined weekly. Eggs laid in the last day of each 28-d laying period were collected and subjected to individual analysis for specific gravity, Haugh units, shell thickness and percentage eggshell. Results showed that average egg production, feed use, and body weights were not affected (P > 0.05) by AFB1. However, feed consumption was lower (P < 0.05) for groups fed 50 or 100 microg AFB1/kg. Egg weight was significantly lower (P < 0.05) only for groups exposed to 50 and 100 microg AFB1/kg. Average egg specific gravity, Haugh units, and shell thickness were not affected (P > 0.05) by AFB1. Percentage eggshell was higher (P < 0.05) in the group fed the ration containing 100 microg AFB1/kg. Treatment associated lesions were observed only in the liver. Hepatic cell vacuolation with fatty infiltration was observed in all liver samples of quail fed AFB1-contaminated rations. Bile duct proliferation and trabecular disorder were found only in livers of quail on the 100-microg AFB1/kg treatment. Results indicated that chronic exposure to AFB1 at levels above 50 microg/kg could adversely affect quail performance, emphasizing the importance of controlling aflatoxin contamination in quail rations.

[Aicardi syndrome: case report]

We report a case of Aicardi syndrome in a female child with 2 month old, ocular abnormalities "chorioretinal lacunae", flexion in spasms, hipsarrhythmic "split brain", callosal agenesis referred to Service of Neuropediatric and Neurophysiology of Base Hospital of São José do Rio Preto, SP, Brazil.

Longstanding presence of HIV-2 infection in Guinea-Bissau (West Africa)

We have retrospectively studied the seroprevalence of the human immunodeficiency virus (HIV) in Guinea-Bissau in a sample of sera collected from the whole country in 1980. We tested a total of 1248 individuals and found 11 individuals who were seropositive for HIV-2 but there were no HIV-1 seropositive samples. The mean age of the HIV-2 seropositive people was significantly higher than the age of the seronegative individuals. In the different areas surveyed, the HIV-2 seroprevalence ranged from 0 to 2.5%. A central region of the country, grossly centred in the capital city of Bissau, presented the highest prevalence of HIV-2 seropositivity (>2%), which contrasts with its virtual absence from the more remote rural areas located near the borders with the neighbouring countries. The overall seroprevalence found for HIV-2 in this study is 0.9% (1.8%, when considering the adult seroprevalence only), which proves that the virus was definitely circulating in Guinea-Bissau at the beginning of the 1980s.

Aflatoxin B1 residues in eggs of laying hens fed a diet containing different levels of the mycotoxin

The present study was carried out to evaluate the excretion of aflatoxin B1 residues in eggs of young laying hens fed aflatoxin B1-contaminated rations for 8 weeks. To this end, 96 twenty-week-old hens were randomly distributed into four experimental groups (24 birds per group) and given rations containing either 0 (controls), 100 micrograms, 300 micrograms or 500 micrograms aflatoxin B1/kg feed. Egg aflatoxin B1 residues were determined by thin layer chromatography; two samples per treatment per week were used for analysis. Egg production and average egg weights were not affected (p < 0.05) in the groups receiving aflatoxin B1-contaminated rations. Residues of aflatoxin B1 were detected only in the eggs of hens given 500 micrograms/kg feed, at levels that ranged from 0.05 to 0.16 microgram/kg (average: 0.10 microgram/kg). The results indicate that the feed to eggs aflatoxin B1 transmission ratio was approximately 5000:1, emphasizing the importance of controlling aflatoxin levels in rations for laying hens.

Efeitos de Diferentes Programas de Alimentação sobre a Ocorrência da Síndrome Ascítica em Frangos de Corte

Foi estudado, para frangos de corte, mediante a utilização de 3 programas de alimentação (3, 4 e 5 fases de arraçoamento), com níveis nutricionais diferenciados, a ocorrência de ascite , sendo que machos e fêmeas foram criados separadamente durante a época do inverno. Utilizou-se 6 repetições por tratamento, sendo 40 aves por repetição. Avaliou-se o desempenho e a mortalidade (total e por ascite), além de se verificar hipertrofia do ventrículo direito e alteração do hematócrito. Não se obteve diferença significativa apenas para os valores do hematócrito, no entanto, melhores resultados foram atingidos na criação de machos em relação às fêmeas (p<0.05) para peso das aves, consumo de ração e peso dos ventrículos (VD e VT). Obteve-se correlação positiva entre a proporção dos ventrículos e a ocorrência de mortalidade por ascite. Verificou-se também que a mortalidade pela síndrome ascítica foi significativamente maior (p<0.05) nas aves machos recebendo 3 fases alimentares, em um programa alimentar mais energético. Baseando-se nas condições sob as quais foi realizado o experimento, pode-se concluir que programas alimentares mais energéticos predispõem à ocorrência de mortalidade pela síndrome ascítica em aves para corte, especialmente as do sexo masculino.

Relative bioavailability of phosphorus in feed and agricultural phosphates for poultry

Nine hundred fifty male Hubbard chicks were used in a 21-d study (10 birds per battery cage) to determine relative bioavailability of P (RBP) in four feed-grade phosphates (FP) [two Brazilian dicalcium and two U.S.-made phosphates (di-monocalcium and defluorinated)] and four Brazilian agricultural grade phosphates (AP) [single (AP-1), and triple (AP-2) superphosphates, monoammonium (AP-3), and thermomagnesium (AP-4) phosphates]. The reference standard was a purified-grade calcium phosphate dibasic (SP). Phosphates were added to the corn-soybean control diet (22% protein; 0.40% P + 0.08% P from SP), providing 0.08 and 0.16% additional P. Calcium level was 1.0% for all diets. Slope ratio was used to determine RBP, with BW, bone ash (BA), or bone strength (BS) regressed on P added within each P source. A relative biological value (RBV) was estimated using BW, BA, and feed efficiency. Performance was depressed (P < 0.01) by AP as compared with FP; BW was decreased by 11%, and feed intake (FI) was decreased by 14%. Mortality increased (P < 0.05) by 154% (7 vs 2.8%). Phosphate source AP-4, which had the lowest content of P and a high content of F, Fe, Ba, Ti, and Th, was toxic based on a 44% decrease (P < 0.01) in BW, 46% decrease in FI, 19% decrease in BA (32.4 vs 40.0%), 55% decrease in BS (7.1 vs 15.8 kg), and mortality increase (P < 0.05) from 0.7 to 26% compared with the average of AP-1, -2 and -3. The RBP could not be estimated for AP-4; and average availabilities for FP and AP, respectively, were 100.6 and 107.6% (BW), 88.3 and 93.2% (BA), 84.2 and 96.3% (BS), and 100.0 and 99.9% (RBP). The AP varied in RBP, with particularly high values calculated for AP-3. Performance and bone parameters in this study were not strongly affected by high levels of potentially toxic mineral elements in certain AP; this result may be explained by the low levels of phosphate addition and the short duration of the feeding period (21 d). However, considering their relatively high levels of F, Fe, Mg, S, Ba, Ti, and Th, agricultural-grade phosphate may represent considerable risk of toxicity for use in animal diets.

Patterns of detection of Strongyloides stercoralis in stool specimens: implications for diagnosis and clinical trials

Reported efficacies of drugs used to treat Strongyloides stercoralis infection vary widely. Because diagnostic methods are insensitive, therapeutic trials generally require multiple negative posttreatment stool specimens as evidence of drug efficacy. However, only a single positive stool specimen is usually required for study enrollment. To determine the reproducibility of detection of S. stercoralis larvae in the stool, 108 asymptomatic infected men submitted 25 g of fresh stool once a week for eight consecutive weeks for examination by the Baermann technique. During the 8-week study, 239 (27.7%) of 864 stool specimens were positive for S. stercoralis. Rates of detection of larvae in the stool specimens ranged from eight of eight specimens in 3 (2.8%) men to none of eight specimens in 36 (33.3%) men. Of 43 men for whom S. stercoralis was detected in at least two of the first four stool specimens, only 1 (2.3%) man tested negative on all of the next four specimens. In comparison, of 29 men who had detectable larvae in only one of the first four specimens, 22 (75.9%) tested negative on all of the next four samples. Thus, if these 29 men had been enrolled in a therapeutic trial between the first and second sets of four specimens, the efficacy of a drug with no activity against this parasite would have been estimated to be 76%. These data suggest that patterns of S. stercoralis detection vary widely among infected persons and that intermittent larval shedding can lead to inflated estimates of drug efficacy. Before a patient is entered in a clinical trial of drug efficacy, four consecutive stool specimens should be examined for S. stercoralis; only persons with two or more positive specimens should be enrolled.

A study of placentas from Wuchereria bancrofti microfilaraemic and amicrofilaraemic mothers

The prevalence of transplacental transfer of microfilariae and structural lesions in the placentas of amicrofilaraemic (n = 10) and Wuchereria bancrofti microfilaraemic (n = 10) pregnant women from the prenatal care unit of the Hospital das Clinicas, Recife, Brazil, was investigated. Study participants were selected by filtration (3 microns/13 mm) of nocturnal (2300-0100 h) venous blood. A detailed histopathological examination was performed to detect abnormalities in the placenta, the cord and the foetal membranes. Both study groups had similar obstetric profiles. Parasitaemia was present during labour in nine of ten microfilaraemic women, but no microfilariae were found by filtration of 5-10 ml cord blood. No macroscopic abnormalities were seen in placentas from microfilaraemic mothers; two placentas from the amicrofilaraemic cases contained, respectively, infarcted areas and cysts at the cut surface. Microscopy failed to detect microfilariae in the intervillous spaces, chorionic and decidual vessels, or the umbilical cord. Thus, transplacental transfer of Wuchereria bancrofti microfilariae seems to be a rare phenomenon, and microfilaraemia does not appear to be a risk factor for placental pathology.

[Transplacental passage of Wuchereria bancrofti microfilariae in newborns of microfilaremic mothers]

The occurrence of circulating Wuchereria bancrofti microfilariae was investigated in 304 pregnant women from the "Unidade Mista Pof. Barros Lima" and "Hospital das Clínicas/UFPE". The filtration technique was employed to detect microfilaraemia during pregnancy, and 13 women were found to be positive (4.2%). The investigation of microfilariae in the cord blood of their children was negative (6/13), and also in venous blood samples collected up to 72 hours after birth and with 6 months of life. Milk samples from these mothers also had no microfilariae. The authors suggest that the occurrence of placentary lesions may be a possible factor involved in the transplacental transfer of microfilariae, and that in utero exposure to microfilariae and/or filarial antigens may influence the response to a filarial infection acquired later, thus being important a clinical and laboratorial follow-up of children exposed previously to filarial antigens during early periods of human development.

[Clinical manifestations of lymphatic bancroftian filariasis]

A review of clinical manifestations of bancroftian filariasis, based on the literature and in the authors' experience, suggests a general classification in to six groups: 1) Normal endemics; 2) Individuals bearing microfilaremia; 3) Acute manifestations; 4) Chronic manifestations; 5) Tropical Pulmonary Eosinophilia; 6) Controversial forms. An overview on diagnostic procedures and the immunologic relationship between host and parasite was made in each group. Final considerations about treatment was also considered.