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Biomedical subjects

P Diz Dios

Publications and source records attributed to P Diz Dios.

At least 19 recordsLinked to original sources

Comparative efficacies of amoxicillin, clindamycin, and moxifloxacin in prevention of bacteremia following dental extractions.

We evaluated the efficacies of oral prophylactic treatment with amoxicillin (AMX), clindamycin (CLI), and moxifloxacin (MXF) in the prevention of bacteremia following dental extractions (BDE). Two hundred twenty-one adults who required dental extractions under general anesthesia were randomly assigned to a control group, an AMX group, a CLI group, and an MXF group (the individuals in the drug treatment groups received 2 g, 600 mg, and 400 mg, respectively, 1 to 2 h before anesthesia induction). Venous blood samples were collected from each patient at the baseline and 30 s, 15 min, and 1 h after the dental extractions. The samples were inoculated into BACTEC Plus aerobic and anaerobic blood culture bottles and were processed in a BACTEC 9240 instrument. Subculture and the further identification of the isolated bacteria were performed by conventional microbiological techniques. The prevalences of BDE in the control group, AMX group, CLI group, and MXF group were 96, 46, 85, and 57%, respectively, at 30 s; 64, 11, 70, and 24%, respectively, at 15 min; and 20, 4, 22, and 7%, respectively, at 1 h. Streptococcus spp. were the most frequently identified bacteria in all groups (44 to 68%), with the lowest percentage being detected in the AMX group (44%). AMX and MXF prophylaxis showed high efficacies in reducing the prevalence and duration of BDE, but CLI prophylaxis was noneffective. As a consequence, MXF prophylaxis is a promising antibiotic alternative for the prevention of BDE when beta-lactams are not indicated.

Adolescent↗

"Scheduling delay" in oral cancer diagnosis: a new protagonist.

Diagnostic delays in oral cancer have been classified as "patient delay" and "delay by the clinicians". However, the influence of the accessibility (scheduling delay) to the health care system in oral cancer diagnosis has not been studied before. To assess scheduling delay, a descriptive, cross-sectional study was designed. This study was based upon role-play telephone conversations with two standardised patients (lingual ulceration-SP1 and patient seeking fixed prosthodontics-SP2). that followed a structured script. The variables considered in the study were days to go until the arranged appointment, professional degree of the contacted person and referral to other provider of care. The scheduling delay for SP1 reached a median value of 1 day, and for SP2 was 6 days. When the professional degree (receptionist vs GDP) of the person arranging the appointment for the patient with lingual ulceration was considered, the scheduling delay was significantly shorter when the appointment was fixed by the GDP (X approximately i-X approximately j=4.5; 95%CI=-7.48,-1.51). GDPs gave priority to the patients with lingual ulcerations over those demanding fixed bridgework (X approximately i-X approximately j=6.48; 95%CI=-9.46,-3.50). The GDPs showed a high level of awareness of the oral cancer, however, educational interventions seem to be necessary for dental surgery receptionists.

Analysis of Variance↗

Detection of HCV-RNA in saliva of HIV-HCV coinfected patients.

The presence of HCV-RNA in saliva of patients with chronic hepatitis C provides a biological basis for the potential transmission of this virus. HCV viremia is particularly high in HCV-HIV-coinfected patients, which could favor the presence of HCV in their saliva. This study was designed to evaluate the prevalence of HCV in saliva of HCV-HIV-coinfected patients. Stimulated whole saliva was collected from 75 HCV-HIV-coinfected patients and 75 HCV controls. The presence of HCV-RNA in saliva was tested by a highly sensitive noncommercialized nested PCR, and analyzed in relation to demographic, clinical, and analytical variables. HCVRNA was detected in the saliva of 49 (65%) HCV-HIV-coinfected patients and 39 (52%) HCV controls. The presence of HCV in saliva was not related to any of the analyzed variables in HCV-HIV-coinfected patients. In the HCV control group a statistically significant relationship was demonstrated only between the detection of HCV-RNA in saliva and the viral load in peripheral blood (p < 0.001). Our results indicate that there is a trend toward a higher HCV-RNA prevalence in the saliva of HCV-HIV-coinfected patients.

Adult↗

HCV clearance patterns in saliva and serum of patients with chronic HCV infection under interferon plus ribavirin therapy.

STATEMENTS OF THE PROBLEM: Hepatitis C virus (HCV)-RNA is often present in saliva of HCV-infected patients, with plasma viral load being the only known predictable factor. Interferon plus ribavirin therapy yields a sustained reduction in HCV viremia. This study aimed to assess the presence of HCV in saliva and serum specimens from patients undergoing this combination therapy (CT). METHOD OF STUDY: Paired serum and saliva specimens were collected from 44 chronic HCV-infected patients at basal time, 4 and 12 weeks after CT onset, at the end of treatment and 6 months latter. Serum HCV-RNA levels were determined by the polymerase chain reaction (PCR) Amplicor system. Presence of HCV-RNA in saliva was tested by a highly sensitive non-commercialized nested-PCR. RESULTS: The HCV-RNA was detected in 26 saliva specimens at basal time (59.1%). In 34.1% of cases, a concordance viral clearance pattern in serum and saliva was observed in both responders (pattern 1a) and non-responders (pattern 1b). In pattern 2 (13.6% of cases), HCV was detected longer during CT in serum than in saliva (pattern 2a) or in saliva than in serum (pattern 2b). In 11.3% of patients, viral clearance was corroborated either in their serum (pattern 3a) or in their saliva (pattern 3b), but not in both fluids. Of the eight primary responders with 1a clearance pattern, seven were sustained responders. None of the patients with 2a clearance pattern was a sustained responder. Of the two primary responders showing the 3b salivary pattern, one had already relapsed in the first 6 months of follow up. CONCLUSIONS: The present results suggest that the monitoring of salivary levels of HCV would be a helpful means of determining sustained antiviral effects of interferon and ribavirin in the treatment of HCV disease.

Adolescent↗

Detection of HCV RNA in saliva of patients with hepatitis C virus infection by using a highly sensitive test.

Hepatitis C virus (HCV) is transmitted primarily by direct percutaneous exposures to blood. Since HCV RNA has been found in saliva, it has been suggested that saliva might also be a source of infection. HCV RNA in saliva from plasma HCV RNA positive patients was tested by a highly sensitive PCR method. HCV RNA was detected in 32 out of 61 saliva specimens (52.4%). No correlation was found between the presence of HCV in saliva and age, sex, identified risk factors for HCV infection, time lapsed since the diagnosis, transaminases and alkaline phosphatase values and stimulated salivary flow. A statistically significant relation between plasma HCV RNA viral load and saliva HCV RNA detection was observed (P<0.001). In conclusion, HCV RNA is often present in saliva of HCV infected patients, with plasma viral load being the only known predictable factor. Further studies on salivary HCV RNA are needed.

Adult↗

An update on infective endocarditis of dental origin.

OBJECTIVES: The aim of this study was to analyse the prevalence of dental treatment and oral infections related to the development of infective endocarditis (IE). METHODS: A retrospective study of 103 cases of IE diagnosed from 1997 to 1999 was conducted in Galicia, Spain. RESULTS: According to the Duke's endocarditis criteria (1994), 87 cases (84.5%) were considered definite IE. A presumed oral portal of entry was recorded in 12 patients (13.7%). Oral infections were held responsible in six cases while the remaining six had received dental treatment in the previous three months (three tooth extractions, one scaling, one cleaning, one fillings). In eight cases of IE (66.6%) typical oral pathogenic microflora was identified, with Streptococcus viridans being the most frequent. In four patients no previous cardiac disease was recorded. CONCLUSIONS: These results suggest that prevalence and characteristics of IE cases of dental origin did not change significantly in the last decades. The need for increased oral hygiene and improved dental care should be emphasized on preventing IE of dental origin. Continued education of physicians and dentists on the importance of the knowledge of current prophylactic protocols should also be considered.

Adolescent↗

Whole stimulated salivary flow in patients with chronic hepatitis C virus infection.

BACKGROUND: Salivary gland disorders have been included among the extra-hepatic manifestations related to HCV infection. METHODS: The whole stimulated salivary flow rate (spitting technique) was studied in 74 HCV infected patients to evaluate salivary gland dysfunction. RESULTS: The salivary flow of the patients with chronic HCV infection was similar to that of the healthy controls. The association between subjective xerostomia salivary flow was seen to be very weak. No significant associations were found between salivary flow and age, sex, risk factor of acquired infection, ALT, AST, GGT, ALP values, time lapsed since the diagnosis or HCV-RNA detection in saliva. CONCLUSIONS: Although the functional repercussion of hepatitis C related lymphocytic sialoadenitis remains unclear, we did not find a significant reduction in the whole stimulated salivary flow in HCV infected patients.

Adult↗

Down syndrome: lip lesions (angular stomatitis and fissures) and Candida albicans.

BACKGROUND: The incidence of angular cheilitis (angular stomatitis, perleche, commissural fissures) appears to be increased in people with Down syndrome (DS). Lip fissures are also (in our clinical impression) a fairly regular feature, yet this is scarcely mentioned in the literature. OBJECTIVES: To establish the incidence of angular cheilitis and lip fissures in a substantial group of patients with DS and to examine the relationship with Candida albicans. PATIENTS AND METHODS: The prevalence of orofacial soft tissue lesions was investigated in a group of 77 DS patients. Swabs were taken from lip lesions, palate and tongue and inoculated on Sabouraud's agar discs for the isolation of C. albicans, identified with commercially available kits. RESULTS: Lip fissures were seen in at least one-quarter of DS patients. Angular cheilitis was also found in a similar percentage. CONCLUSIONS: C. albicans was isolated from a substantial proportion of lesions tested, and was present more frequently than in those without lip lesions, but it is uncertain whether this represents cause or effect.

Adolescent↗

[Guidelines for antibiotic prophylaxis of bacterial endocarditis in patients undergoing dental therapy].

The objective of the present work was to know the guidelines of antibiotic prophylaxis in bacterial endocarditis used in different spanish health centers. A general dental practitioner asked orally in 50 Cardiology and/or Internal Medicine departments throughout Spain which prophylaxis should be administered to a patient with a mitral valve prosthesis before a dental extraction. The results obtained showed that only 36 (72%) departments used the latest prophylactic guidelines recommended by the American Heart Association or the British Society for Antimicrobial Chemotherapy. Among penicillin allergic patients the antibiotic of choice was erythromycin (60%) followed by clindamycin (28%), although administered at very different dosages (11 and 3, respectively). Only in 44% of the surveyed departments did the guidelines for allergic and non allergic patients correspond to the recommended protocol by the same study group. The controversy generated regarding the prophylactic indications for bacterial endocarditis might partially account for the results obtained in this study.

Antibiotic Prophylaxis↗

Orofacial effects of antiretroviral therapies.

This paper summarises some of the oral adverse effects of antiretroviral agents. Some are related to bone marrow suppression which may also predispose to mouth ulcers. Erythema multiforme and toxic epidermal necrolysis are especially well recognized in HIV disease, particularly as reactions to sulphonamides and to antiretroviral agents. Oral lichenoid reactions have been described in HIV disease often relating to zidovudine use. Didanosine has also produced erythema multiforme and not unusually induces xerostomia, again by an unknown mechanism. Xerostomia may be seen in up to one-third of patients taking didanosine. Taste abnormalities are common with the protease inhibitors and oral and perioral paraesthesia can be a disturbing adverse effect. Ritonavir in particular can give rise to circumoral paraesthesia in over 25% of patients. Indinavir can also produce cheilitis.

Anti-HIV Agents↗

Thalidomide for the treatment of acquired immunodeficiency syndrome-associated refractory oral ulcers.

A case of severe, oral, not otherwise specified ulcers in a human immunodeficiency virus-infected patient is described. The lesions did not respond to acyclovir, prednisone, pentoxifylline, or foscarnet sodium therapy. Dramatic clinical improvement and progressive ulcer healing were observed after starting oral thalidomide therapy. Clinicians should be aware of the usefulness of thalidomide for the treatment of acquired immunodeficiency syndrome-associated not otherwise specified ulcerations.

Acquired Immunodeficiency Syndrome↗

Intra-alveolar granulocytic sarcoma developing after tooth extraction.

Granulocytic sarcoma (GS) is a malignant tumour composed of poorly differentiated myeloid cells forming in an extramedullary site. It is generally associated with acute leukaemia, particularly the myelocytic type. Its appearance in patients with chronic myeloid leukaemia is exceptional. GS can appear in multiple locations with the oral cavity being rarely involved. A mandibular GS detected in a patient with chronic myeloid leukaemia 10 days after a tooth extraction is reported. The pathogenesis (by metastatic cells or migration through the Haversian canals) of the tumour is discussed.

Diagnosis, Differential↗