PURPOSE: To analyze cone-beam computed tomography (CBCT) use, indications, and exposure parameters in San José, Costa Rica. MATERIALS AND METHODS: A cross-sectional study was performed. All CBCT examinations over a period of 6 months at 2 radiological centers in San José, Costa Rica were evaluated. The examinations were performed with Veraview EPOC X550 and Veraviewepocs 3D R100 equipment. The patients' age and sex, clinical indication for CBCT, region of interest (ROI), repeat examinations, specialty of the referring dentist, field-of-view (FOV), tube voltage (kV), tube current (mA), and radiation dose (µGy) were evaluated. Patients were classified by age as children (≤12 years), adolescents (13–18 years), and adults (≥19 years). RESULTS: The mean age of the 526 patients was 49.4 years. The main indications were implant dentistry and dental trauma. The most frequent ROIs were posterior, while anterior ROIs were much less common. The highest percentage of repeat examinations was in children. Fifty-six percent of the referring dentists were specialists. The most commonly used FOV was small. The mean tube voltage and current were 79.8 kV and 7.4 mA for Veraview EPOC X550 and 89.9 kV and 6 mA for Veraviewepocs 3D R100, respectively. The mean doses for children, adolescents, and adults were 6.9 µGy, 8.4 µGy, and 7.8 µGy, respectively. CONCLUSION: Although CBCT was most commonly used in adults for implant dentistry, most repeat examinations were in children, and the highest mean dose was in adolescents. Additional dose optimization efforts should be made by introducing low-dose protocols for children and adolescents.
Adolescent ; Adult ; Child ; Cone-Beam Computed Tomography ; Costa Rica ; Cross-Sectional Studies ; Dentistry ; Dentists ; Humans ; Radiation Dosage ; Radiation Protection ; Specialization

PURPOSE: Non-classical actions of vitamin D as a cytokine are related to the immunopathology of asthma. Few studies have examined vitamin D levels and asthma severity in adults. The aim of this research was to assess the relationship between vitamin D levels, atopy markers, pulmonary function, and asthma severity. METHODS: We analyzed 25-hydroxyvitamin D levels in serum collected from 121 asthmatic adults from Costa Rica to investigate the association between vitamin D levels (categorized as sufficient, > or =30 ng/mL, or insufficient, <30 ng/mL), allergic rhinitis, total IgE and peripheral blood eosinophils (as markers of atopy), asthma severity, baseline forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC). Univariate and multivariate analyses were performed to assess these relationships. RESULTS: When the population was stratified by vitamin D status, 91% of asthmatic patients with vitamin D levels below 20 ng/mL (n=36) and 74% of patients with vitamin D levels between 20 and 30 ng/mL (n=73) had severe asthma versus 50% of those with vitamin D sufficiency (n=12; P=0.02). Vitamin D insufficiency was associated with a higher risk of severe asthma (odds ratio [OR], 5.04; 95% Confidence interval [CI], 1.23-20.72; P=0.02). High vitamin D levels were associated with a lower risk of hospitalization or emergency department visit during the last year (OR, 0.90; 95% CI, 0.84-0.98; P=0.04). Although there appeared to be a direct relationship between vitamin D levels and FEV1 (regression coefficient=0.48; r2=0.03), it did not reach statistical significance (P=0.07). CONCLUSIONS: Our findings suggest that vitamin D insufficiency is common among our cohort of asthmatic adults. Lower vitamin D levels are associated with asthma severity.
Adult ; Asthma ; Cohort Studies ; Costa Rica ; Emergencies ; Eosinophils ; Forced Expiratory Volume ; Hospitalization ; Humans ; Immunoglobulin E ; Multivariate Analysis ; Rhinitis ; Rhinitis, Allergic, Perennial ; Vital Capacity ; Vitamin D ; Vitamins

BACKGROUND: Atopic march (AM) is the progression from atopic dermatitis (AD) to allergic rhinitis and asthma. The development of AD is as high as 20% in children worldwide and continues to increase. AD seems to be caused by both genetic and environmental factors. Recently, polymorphisms of the thymic stromal lymphopoietin (TSLP) gene associated with allergic disorders were reported in ethnic groups from various countries. OBJECTIVE: Identification of TSLP polymorphisms in Koreans with AD or AM. METHODS: Whole-exome sequencing was performed in 20 AD and 20 AM patients. RESULTS: Nine single nucleotide polymorphisms (SNPs) of TSLP were detected (rs191607411, rs3806933, rs2289276, rs2289277, rs2289278, rs139817258, rs11466749, rs11466750, rs10073816). These SNPs have been correlated with susceptibility to allergic diseases in ethnic groups from China, Japan, Turkey, and Costa Rica in previous studies. Remarkably, one of 20 patients in the AD group lacked all SNPs, compared to six of 20 patients in the AM group. Odds ratios showed that Korean patients without the nine TSLP variants had an 8.14 times higher risk of moving from AD to AM. Two haplotype blocks were validated in 60 AD and 59 AM patients using Sanger sequencing. The haplotype blocks (rs3806933 and rs2289276) and (rs11466749 and rs11466750) were in high linkage disequilibrium, respectively (D′=0.97, D′=1). CONCLUSION: The increase of major allele frequency of respective nine TSLP variants may enhance the risk of AM. These data will contribute to improved genetic surveillance system in the early diagnosis technology of allergic disease.
Asthma ; Child ; China ; Costa Rica ; Dermatitis, Atopic* ; Early Diagnosis ; Ethnic Groups ; Gene Frequency ; Haplotypes ; Humans ; Japan ; Linkage Disequilibrium ; Odds Ratio ; Polymorphism, Single Nucleotide ; Rhinitis, Allergic ; Turkey