PURPOSE: The purpose of this study was to compare serum amyloid A (SAA) protein levels with high-sensitive C-reactive protein (hs-CRP) levels as markers of systemic inflammation in patients with chronic periodontitis. The association of serum titers of antibodies to periodontal microbiota and SAA/hs-CRP levels in periodontitis patients was also studied. METHODS: A total of 110 individuals were included in this study. Patients were assessed for levels of hs-CRP and SAA. Nonfasting blood samples were collected from participants at the time of clinical examination. The diagnosis of adipose tissue disorders was made according to previously defined criteria. To determine SAA levels, a sandwich enzyme-linked immunosorbent assay was utilized. Paper points were transferred to a sterile tube to obtain a pool of samples for polymerase chain reaction processing and the identification of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, and Tannerella forsythia. The serum level of IgG1 and IgG2 antibodies to P. gingivalis, A. actinomycetemcomitans, and T. forsythia was also determined. RESULTS: SAA and hs-CRP levels were higher in periodontitis patients than in controls (P<0.05). In bivariate analysis, high levels of hs-CRP (>3 mg/L) and SAA (>10 mg/L) were significantly associated with chronic periodontitis (P=0.004). The Spearman correlation analysis between acute-phase proteins showed that SAA positively correlated with hs-CRP (r=0.218, P=0.02). In the adjusted model, chronic periodontitis was associated with high levels of SAA (odds ratio [OR], 5.5; 95% confidence interval [CI], 1.6-18.2; P=0.005) and elevated hs-CRP levels (OR, 6.1, 95% CI, 1.6-23.6; P=0.008). Increased levels of serum IgG2 antibodies to P. gingivalis were associated with high levels of SAA (OR, 3.6; 95% CI, 1.4-8.5; P=0.005) and high concentrations of hs-CRP (OR, 4.3; 95% CI, 1.9-9.8; P<0.001). CONCLUSIONS: SAA and hs-CRP concentrations in patients with chronic periodontitis are comparably elevated. High serum titers of antibodies to P. gingivalis and the presence of periodontal disease are independently related to high SAA and hs-CRP levels.
Acute-Phase Proteins ; Adipose Tissue ; Aggregatibacter actinomycetemcomitans ; Antibodies ; C-Reactive Protein* ; Chronic Periodontitis ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Forsythia ; Humans ; Immunoglobulin G ; Inflammation ; Microbiota ; Periodontal Diseases ; Periodontitis* ; Polymerase Chain Reaction ; Porphyromonas gingivalis ; Serum Amyloid A Protein*

PURPOSE: To evaluate whether the levels of immunoglobulin G (IgG) antibody to Tanerella forsythia are associated with periodontal status. METHODS: Patients with a diagnosis of chronic periodontitis were considered candidates for the study; thus 80 chronic periodontitis patients and 28 healthy persons (control group) were invited to participate in this investigation. The presence of T. forsythia was detected by polymerase chain reaction (PCR) analysis using primers designed to target the respective 16S rRNA gene sequences. Peripheral blood was collected from each subject to identify the IgG1 and IgG2 serum antibodies against T. forsythia. All microbiological and immunological laboratory processes were completed blindly, without awareness of the clinical status of the study patients or of the periodontal sites tested. RESULTS: The bivariate analysis showed that lower mean levels of clinical attachment level (CAL) and probing depth were found in the presence of the IgG1 antibody titers against whole-cell T. forsythia; however, only the difference in CAL was statistically significant. In the presence of the IgG2 antibody titers against whole-cell T. forsythia, the periodontal parameters evaluated were higher but they did not show statistical differences, except for plaque. The unadjusted linear regression model showed that the IgG1 antibody against whole-cell T. forsythia in periodontitis patients was associated with a lower mean CAL (beta=-0.654; 95% confidence interval [CI], -1.27 to -0.28; P<0.05). This statistically significant association remained after adjusting for possible confounders (beta=-0.655; 95% CI, -1.28 to -0.29; P<0.05). On the other hand, smoking was a statistically significant risk factor in the model (beta=0.704; 95% CI, 0.24 to 1.38; P<0.05). CONCLUSIONS: Significantly lower mean levels of CAL were shown in the presence of the IgG1 antibody titers against whole-cell T. forsythia in periodontitis patients. Thus, the results of this study suggest that IgG1 antibody to T. forsythia may have been a protective factor from periodontitis in this sample.
Antibodies ; Chronic Periodontitis ; Diagnosis ; Forsythia* ; Genes, rRNA ; Hand ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Linear Models ; Periodontal Diseases ; Periodontitis ; Polymerase Chain Reaction ; Risk Factors ; Smoke ; Smoking

There are many factors involved in the effectiveness and efficiency of psychiatric drug treatment. One of them is psychotropic drug metabolism, which takes place mostly in the liver through the P450 enzyme system. However, there are genotypic variants of this system’s enzymes that can directly affect both the efficacy and the onset of side effects of a given therapeutic regimen. These genotypic changes could partly explain the lack of efficacy of treatment in certain patients. We report the case of a patient diagnosed with bipolar type I disorder that presented multiple and frequent manic episodes in which the efficacy and tolerability of several pharmacological regimens with mood stabilizers and antipsychotics was scarce. The choice of medical treatment should be based on its efficacy and side effect profile. This decision can be made more accurately using the information provided by pharmacogenetic analysis. This case illustrates the importance of pharmacogenetic studies in clinical practice. The results of pharmacogenetic analysis helped to decide on a better treatment plan to achieve clinical improvement and reduce drug-induced adverse effects.
Antipsychotic Agents ; Bipolar Disorder ; Cytochrome P-450 Enzyme System ; Humans ; Liver ; Metabolism ; Pharmacogenetics ; Precision Medicine

PURPOSE: The purpose of this study was to propose and assess a shade guide for pink gingival aesthetics using a Spanish population sample. MATERIALS AND METHODS: The L*, C*, h, a* and b* coordinates of 259 participants were measured using a spectrophotometer in 3 standardized points along the attached gingiva of the maxillary central incisors. A hierarchical clustering analysis was applied to obtain separate solutions regarding the number of shade tabs. For each of the solutions obtained, color differences (ΔE*) were calculated using the CIELab and CIEDE2000 formulas, and the proposed shade guide was selected considering (1) the color differences between tabs and (2) the coverage error of each of the solutions. RESULTS: The proposed shade guide consisted of 8 gingival shade tabs and achieved CIELab and CIEDE2000 coverage errors of less than the respective 50:50% acceptability thresholds (ΔE*=4.6 units and ΔE₀₀=4.1). The coordinates for the various gingival shade tabs were as follows: Tab 1: L*43.3, a*21.9, b*12.3 (1.6); Tab 2: L*42.9, a*34.1, b*19.1; Tab 3: L*46.5, a*25.8, b*10.9; Tab 4: L*46.5, a*27.3, b*15.1; Tab 5: L*49.6, a*23.5, b*16.8; Tab 6: L*51.5, a*19.7, b*13.6; Tab 7: L*55.9, a*22.0, b* 15.0; and Tab 8: L*56.0, a*19.9, b*18.8. CONCLUSION: The CIELab and CIEDE2000 coverage errors for the 8 shade tabs of the proposed gingival shade guide were significantly lower than those of other guides. Therefore, despite the limitations of this study, the proposed guide is more appropriate for matching gingival shade in the Spanish general population.
Esthetics ; Gingiva ; Incisor

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imagingreporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imagingreporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

Objectives: The study and use of marine and fresh water microalgae in therapy is a very recent phenomenon. Fresh water microalgae are used in food and to a lesser extent in cosmetics, however, not much is known about the applications of marine microalgae.   The Department of Applied Physics at the University of Vigo (Spain) has developed a marine microalgae culture system, and the species obtained are used to prepare products fit for thalassotherapy and spa treatments.   The aim of this study is to develop a procedure for designing, manufacturing and characterising spa products made from marine microalgae. Method: The growing interest in natural tested quality products for use in Spas has stimulated the search for product mixtures frequently used in Spas, such as clays and medicinal-mineral waters, with laboratory cultivated microalgae to guarantee quality and optimum growth.   A review of scientific literature on the applications of marine microalgae in skin care was the first stage in this study.   Marine microalgae are a source of vitamins, pigments, proteins and other beneficial substances for the skin (Spolaore et al, 2006). Only a few microalgae species are consolidated in the skin care market, wherein the principal ones are Chlorella and Spirulina (Stolz et al, 2005). Protein rich extracts of Spirulina have been used in cosmetics for preventing stretch marks and extracts from Chlorella vulgaris have been used to stimulate collagen synthesis in skin, thereby fostering tissue regeneration and reduction of wrinkles (Stolz et al, 2005). Other microalgae used are Nannochloropsis oculata and Dunaliella salina. Tests done with an extract of Nannochloropsis oculata have shown that this microalga acts as an optimum protective sheath against oxidative stress and positively influences collagen synthesis (Stolz et al, 2005). An ingredient of Nannochloropsis oculata has excellent skin elasticity properties (short and long-term) and was already in the market in 2005 (Stolz et al, 2005).   Microalgae culture has been on the rise in the past years. This is generally done in tanks or pools using a controlled culture medium and with either natural or fluorescent light that imitates the natural solar cycle (photobioreactors).   A species of Nanocloropsis was selected to study its use in Spas. This is an alga which can be cultivated using photobioreactors such that its growth and profitability can be controlled.   Mixtures with varying proportions of clays and mineral waters and seawaters were prepared.   Research equipment was used to analyse the behaviour of the mixtures. To that end, density, specific heat and thermal conductivity, which are important thermophysical properties, were used to assess these products for heat therapy. Results and Discussion: The preliminary studies have provided results on culture conditions of the microalgae. Results of heat behaviour were also collected using varying mixtures of clays and waters.   These results show that marine microalgae can be used in Spa treatments either in baths or as poultices, thus indicating that thermal retention capacity is improved upon mixture with clays, an aspect which is important for their use in heat therapy.

OBJECTIVE: This report aims to raise physician clinical awareness of radial artery pseudoaneurysm (RAP) and promote early recognition of this potentially serious complication. The article highlights various proposed treatment strategies in the management of this condition. BACKGROUND: Radial artery pseudoaneurysm is a rare potentially serious complication following transradial artery coronary angiography for left heart catheterization and percutaneous coronary intervention. Risk factors associated with the development of RAP include multiple arterial puncture attempts, use of systemic anticoagulation, inadequate hemostasis following post-procedural compression, vascular site infection, use of larger sheaths, female gender, age of 70 years and older, diabetes mellitus, obesity and/or patients with high body mass index.1-3 Conservative medical treatment and/or surgical repair are the primary therapeutic approaches in the management of RAP. CONCLUSION Transradial artery access is associated with a significantly lower risk of major bleeding and vascular access site complications, reduces morbidity and mortality compared with the transfemoral approach. It is important to recognize though that complications do still occur with the transradial approach. RAP is one such entity wherein prevention is key - with adequate post-procedural compression, frequent observation, and careful assessment of the radial access site.
Aneurysm, False ; Radial Artery

PURPOSE: Classical criteria for diagnosis of autoimmune hepatitis (AIH) are intended as research tool and are difficult to apply at patient's bedside. We aimed to study the accuracy of simplified criteria and the concordance with the expert diagnosis based on the original criteria. METHODS: A cohort of children under study for liver disorder was selected through consecutive sampling to obtain the prevalence of AIH within the group of differential diagnoses. AIH was defined, based on classical criteria, through committee review of medical reports. Validity indicators of the simplified criteria were obtained in an intention to diagnose approach. Optimal cut-off and the area under the receiver operating characteristic (ROC) curve were calculated. RESULTS: Out of 212 cases reviewed, 47.2% were AIH. For the optimal cut-off (6 points), the simplified criteria showed a sensitivity of 72.0% and a specificity of 96.4%, with a 94.7% positive and a 79.4% negative predictive value. The area under the ROC curve was 94.3%. There was a good agreement in the pre-treatment concordance between the classical and the simplified criteria (kappa index, 0.775). CONCLUSION: Simplified criteria provide a moderate sensitivity for the diagnosis of AIH, but may help in indicating treatment in cases under suspicion with 6 or more points.
Child* ; Cohort Studies ; Diagnosis* ; Diagnosis, Differential ; Hepatitis, Autoimmune* ; Humans ; Intention ; Liver ; Prevalence ; ROC Curve ; Sensitivity and Specificity

Background: Antibiotic Stewardship Programs (ASP) have improved empirical and directed antibiotic treatment in Gram-negative Bacilli (GNB) bloodstream infections. A decrease in mortality, readmission, and length of hospitalization has been reported. Materials and Methods: A pre–post-quasi-experimental study was conducted between November and April 2015–2016 (pre-intervention period), 2016–2017, 2017–2018, and 2018–2019 (post-intervention periods), to analyse the impact of ASP on empirical, directed, and entire treatment optimization, as well as mortality, readmission, and length of hospitalization, in hospitalized patients with Gram-negative bacilli (GNB) bloodstream infections. Results: One hundred seventy-four patients were included (41 in the pre-intervention group, 38 in the first-year post-intervention group, 50 in the second-year post-intervention group, and 45 in the third-year post-intervention group). There was a significant improvement in directed treatment optimization (43.9% in the pre-intervention group, 68.4% in the first-year post-intervention group, 74% in the second-year post-intervention group, and 88.9% in the third-year post-intervention group, P <0.001), as well as in entire treatment optimization (19.5%, 34.2%, 40.0%, and 46.7%, respectively, P=0.013), with increased optimal directed (adjusted odds ratio [aOR], 3.71; 95% confidence interval [CI], 1.60–8.58) and entire treatment (aOR, 3.31; 95% CI, 1.27–8.58). Although a tendency toward improvement was observed in empirical treatment after ASP implementation, it did not reach statistical significance (41.5% vs. 57.9%, P=0.065). No changes in mortality, readmission, or length of hospitalization were detected. Conclusion ASP implementation improved both directed and entire treatment optimization in patients with GNB bloodstream infections over time. Nevertheless, no improvement was found in clinical outcomes such as mortality, readmission, or length of hospitalization.