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To evaluate the effectiveness of photobiomodulation therapy (PBMT) in reducing gingivitis following professional dental prophylaxis in dogs in a prospective, randomly controlled, double-blind study. The study included 47 dogs (male n = 23, female n = 24), with a mean age of 6.5 ± 2.6 years and a bodyweight of 28.9 ± 5.3 kg. Breeds included: Belgian Malinois Shepherd Dogs (n = 23), German Shepherd Dogs (n = 14), Labrador Retriever (n = 4), and Dutch Shepherd Dogs (n = 3). The left side of the mouth was treated by performing dental prophylaxis (control group). The right side received dental prophylaxis and a single session of PBMT using a Class IV therapeutic laser (treatment group). Each side was graded individually for periodontal disease (PD), gingivitis, and calculus. Follow-up observations were conducted on days 1, 3, 8, and 15 post-treatment. Results were compared using a Mann-Whitney Test. Multiple regression was run to predict PD, gingivitis, and calculus scores using age, sex, and breed. A p <.05 was considered significant. The PBMT group (PG) showed significantly lower gingivitis scores from day 1 to 15 post-treatment. PD had an increasing prevalence with age. Age and breed contributed to the prediction of PD, gingivitis, and calculus grading. This study showed that PBMT significantly reduced the grade of gingivitis following dental prophylaxis, and may be a useful adjuvant procedure following dental prophylaxis. [ABSTRACT FROM AUTHOR]

This article builds upon Paul Preciado's conceptualisation of pharmaco-pornographic power to understand the ongoing affects and effects of Pre-Exposure Prophylaxis (PrEP) on queer men's sexual socialities and subjectivities. Drawing from a new-materialist epistemology, we analyze data from a sexual health pilot study in NYC to trace the techno-sexual health assemblages forming in queer life worlds. Our analysis suggests that these assemblages, entangling PrEP and other pharmacological substances, pornographic imaginaries together with mediatic technologies and public health rationalties, are creating paradoxical desires and practices of intimacy that are both normative and exceed rational health-actor logics and normative understandings of risk. These effects have population-level biopolitical implications. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this article is to review the available trials that led to the Food and Drug Administration (FDA) approval of berotralstat, an oral kallikrein inhibitor, for the prevention of hereditary angioedema (HAE) attacks. Data Sources: PubMed and ClincalTrials.gov were searched using key term berotralstat to identify phase III clinical trials related to the FDA approval of berotralstat from April 2018 to May 2021. Study Selection and Data Extraction: Trials selected were those that influenced the FDA approval of berotralstat or provided novel information regarding the safety and efficacy of this therapy in the treatment of HAE. Data Synthesis: Both APeX-2 and ApeX-J found clinically significant benefit with berotralstat 150 mg daily for reduction in HAE attacks when compared with placebo (1.31 vs 2.35, P < 0.001, and 1.11 vs 2.18, P < 0.001, attacks in the APeX-2 and APeX-J trials, respectively). APeX-2 also showed a statistically significant benefit for berotralstat 110 mg daily (1.65 vs 2.35 attacks [1.65 attacks, P = 0.024]). Relevance to Patient Care and Clinical Practice: An advantage berotralstat has over the other approved therapies is that it is administered orally, which may garner patient preference because of ease of administration. Berotralstat has also shown a potential benefit in reducing the need for standard-of-care treatment for HAE attacks, which has not been studied with alternative agents. Conclusions: Berotralstat 150 mg daily has been proven safe and effective in clinical studies and appears to be a viable oral alternative to parenteral medications currently used in HAE prophylaxis. [ABSTRACT FROM AUTHOR]

It is well established that adverse childhood experiences (ACEs) negatively impact physical and mental health. There is a paucity of research examining the impact of ACEs on oral health. Therefore, the aim of this study was to better understand how ACEs may impact oral health utilizing a nationally representative sample of females. Data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS) were utilized. The sample comprised 36,249 females. Chi-square tests were used to examine associations between multiple forms of ACEs and oral health, mental health, smoking, and health-related quality of life. Logistic regression models were generated for the outcomes of interest: last dental cleaning, significant tooth loss, smoking, and health-related quality of life. Post-hoc analyses were conducted to examine whether smoking and dental cleaning moderated the relationship between ACEs and significant tooth loss. All ACE categories were significantly associated with poor health-related quality of life, being a current or former smoker, last dental cleaning >1 year, and significant tooth loss even after adjusting for demographic variables. Last dental cleaning and being a current or former smoker moderated the relationship between ACEs and significant tooth loss. This study affirms other findings that women with a history of ACEs were more likely to engage in health-risk behaviors, specifically cigarette smoking, which has been strongly associated with ACEs. These findings underscore the importance of including oral health in future studies given it has implications for disease development. Furthermore, dental visits may provide a window of opportunity for trauma-informed care. [ABSTRACT FROM AUTHOR]

Periodontal disease has been identified in horses and donkeys through the millennia at a prevalence of up to 75% and is a leading cause of tooth loss in horses. We hypothesize that there is a correlation between tooth elongations and periodontal disease. Dental records of all client owned horses examined by a single AVDC/equine board certified practitioner in 2016-2018 were analyzed. Inclusion criteria consisted of the examination finding of tooth elongation of one of the following teeth pairs 106/107, 206/207, 310/311, or 410-411. The included cases were then examined for the finding of periodontal disease in Stages 1-4 (PD 1-4). Bayesian correlation analysis revealed significant positive correlations of elongations and periodontal disease existed between PD1 and proximal tooth pairs 106-107 and 206-207, PD2 and PD4 with all four tooth pairs, and PD3 with 106-107. Clinically, early diagnosis and treatment of newly formed elongations, or prevention of their formation altogether through diligent dental prophylaxis could prove key in preservation of teeth through prevention of the associated development of periodontal disease in the horse. [ABSTRACT FROM AUTHOR]

The prophylactic removal of asymptomatic third molars is a common but controversial procedure often rationalized as necessary to prevent future disease on adjacent teeth. Our objective in this retrospective cohort study of adult men was to examine whether second-molar loss differed by baseline status of the adjacent third molar, taking into account the individual's overall state of oral hygiene, caries, and periodontitis. We analyzed data from participants of the VA Dental Longitudinal Study who had at least 1 second molar present at baseline and 2 or more triennial dental examinations between 1969 and 2007. We classified second molars by third-molar status in the same quadrant: unerupted, erupted, or absent. Tooth loss and alveolar bone loss were confirmed radiographically. Caries and restorations, calculus, and probing depth were assessed on each tooth. We estimated the hazards of second-molar loss with proportional hazards regression models for correlated data, controlling for age, smoking, education, absence of the first molar, and whole-mouth indices of calculus, caries, and periodontitis. The analysis included 966 men and 3024 second molar/first molar pairs. Follow-up was 22 ± 11 y (median 24, range 3–38 y). At baseline, 163 third molars were unerupted, 990 were erupted, and 1871 were absent. The prevalence of periodontitis on the second molars did not differ by third-molar status. The prevalence of distal caries was highest on the second molars adjacent to the erupted third molars and lowest on the second molars adjacent to the unerupted third molars. Relative to the absent third molars, adjusted hazards of loss of second molars were not significantly increased for those adjacent to erupted (hazard ratio [HR] = 0.96, 95% confidence interval [CI] = 0.79–1.16) or unerupted (HR = 1.25, 95% CI = 0.91–1.73) third molars. We found similar results when using alveolar bone loss as the periodontitis indicator. Our findings suggest that retained third molars are not associated with an increased risk of second-molar loss in adult men. [ABSTRACT FROM AUTHOR]

Thromboprophylaxis following arthroscopic knee surgery (AKS) is not clear in the literature. The purpose of this study was to present the incidence of symptomatic deep vein thrombosis (DVT) following elective AKS over the age of 40. The secondary purpose was to investigate risk factors associated with venous thromboembolic events (VTEs). Surgical database and outpatient clinic follow-up charts of the patients who underwent AKS for any reason were included in the study. Odds for risk factors such as previous medical history of thrombosis, any family history for clotting disorders, diabetes mellitus (DM), oral contraceptive usage, body mass index, history of malignancy, and smoking were evaluated. The incidence of DVT following AKS significantly increased in the patients older than 40 years who had a previous medical history of VTE, DM, and smoking. A variety of guidelines exist for VTE prophylaxis; however, one should focus on risk factors related to the patient's medical history and current medical conditions. In this study, smoking, DM, and previous history of DVT increased DVT risk significantly, and thromboprophylaxis should be kept in mind for these patients. [ABSTRACT FROM AUTHOR]

Oral pre-exposure prophylaxis (PrEP) has the ability to curb HIV incidence worldwide and bring us closer to ending the HIV epidemic. Scale up of PrEP service delivery has many similar challenges to those faced by voluntary medical male circumcision (VMMC) services roll-out. This article outlines ten important lessons learned during the scale up of VMMC services in sub-Saharan Africa and their application to current oral PrEP implementation efforts to promote faster expansion for public health impact. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the association of different dental prophylactic modalities and osteoradionecrosis (ORN) and determine the risk of ORN under different timing periods of scaling, with the use chlorhexidine mouth rinse after surgery and with different strategies of fluoride gel application in head and neck cancer (HNC) participants. A cohort of 18,231 HNC participants, including 941 ORN patients and 17,290 matched control cases, were enrolled from a Longitudinal Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) in Taiwan. Based on different dental prophylactic modalities before radiotherapy, including chlorhexidine mouth rinse, scaling, and fluoride gel, all HNC subjects were stratified into different groups. The Cox proportional hazard regression was used to compare ORN incidences under different dental prophylactic modalities. The results revealed that scaling and chlorhexidine mouth rinse were significantly related to ORN risk ( P = 0.004 and P < 0.0001). Chlorhexidine mouth rinse was highly correlated to ORN occurrence (hazard ratio [HR], 1.83-2.66), as exposure increased the risk by 2.43-fold among oral cancer patients, regardless of whether they had received major oral surgery or not. Oral cancer patients receiving scaling within 2 wk before radiotherapy increased their incidence of ORN by 1.28-fold compared with patients who had not undergone scaling within 6 mo. There is no significance of fluoride application for dental prophylaxis in increasing ORN occurrence. In conclusion, dental prophylaxis before radiotherapy is strongly correlated to ORN in HNC patients. Chlorhexidine exposure and dental scaling within 2 wk before radiotherapy is significantly related to ORN risk, especially in oral cancer patients. The use of 1.1% NaF topical application did not significantly increase the risk of ORN in HNC patients. An optimal dental prophylaxis protocol to reduce ORN should concern cancer location, cautious prescription of chlorhexidine mouth rinse, and proper timing of scaling. [ABSTRACT FROM AUTHOR]

Several studies on the effect of inhaled plutonium-dioxide particulates and the incidence of lung tumors in dogs reveal beneficial effects when the cumulative alpha-radiation dose is low. There is a threshold at an exposure level of about 100 cGy for excess tumor incidence and reduced lifespan. The observations conform to the expectations of the radiation hormesis dose-response model and contradict the predictions of the LNT hypothesis. These studies suggest investigating the possibility of employing low-dose alpha-radiation, such as from 239PUO2 inhalation, as a prophylaxis against lung cancer. [ABSTRACT FROM AUTHOR]

With an escalating trend of regenerative treatments for periodontal diseases, scientists seek to develop techniques and materials to aid in the formation of new tissues to replace the damaged tissues. Thus, the introduction of various metallic and polymeric materials structured in nano scales and nanomaterials are developed to form an ideal scaffold interfaces with the tissues which provides a new horizon in the periodontal therapy. Nanomaterials can be used to provide aid in the treatment of dentinal hypersensitivity, can be used in dentifrices, nanofibers can be used as an adjunct to conventional fibers for local drug delivery and tissue engineering scaffolds, they can also be used for nano biomineralization, biomimicry or tooth repair, and nano textured implant surface. Thus, the development of nanomaterials can be a boon for periodontal management as far as its potential is considered in managing, diagnosing, and treating periodontal diseases. [ABSTRACT FROM AUTHOR]

The article discusses the erroneous and ineffective post-exposure prophylaxis (PEP) treatments of rabies in Iran. The association of PEP to the death of rabies-inflicted patients is noted. It is expected that timely PEP education and rabies awareness programmes extension based on rabies control measures implementation is pointed out.

The article discusses a study to review the rationale for recommendation of the concomitant use of anticonvulsant in patients on clozapine and discuss the relationship between clozapine dose, serum concentration and risk for seizures affecting clozapine levels and provide recommendations for the management of clozapine-induced seizures. It suggests that primary and secondary prophylaxis of clozapine related-seizures should depend more on clinical and blood concentration monitoring.

Abstracts of several topical presentations at the 2013 Spring Conference of British Association for Sexual Health and HIV (BASHH) in Bristol, England are presented including the prescriptions and outcomes of postexposure prophylaxis after sexual intercourse, the documentation of sexual history and HIV testing, and routine investigation and monitoring of adult HIV infected individuals.

Stringent eligibility criteria, drug costs and antiretroviral toxicities are challenges in delivering HIV non-occupational post-exposure prophylaxis (nPEP). We reviewed patients’ nPEP eligibility and clinical outcomes at St Michael's Hospital, Toronto, Canada to identify opportunities for improvement. Of 241 patients, 59%, 36% and 6% presented for high- (receptive anal/vaginal, blood), medium- (insertive anal/vaginal) and low-risk (oral) sexual exposures, respectively, and nearly all (93%) presented within 72 hours. Of 205 patients given nPEP, 20 were known to have discontinued nPEP prematurely: three due to costs but none due to toxicities. Two HIV seroconversions occurred in patients with suspected ongoing potential exposures. Five asymptomatic syphilis diagnoses were made among 71 tested. Only 39% and 19% of nPEP patients returned to our institution for follow-up at 3–4 and six months, respectively. Our findings underscore the feasibility and importance of nPEP programmes to HIV and sexually transmitted infection control, while identifying opportunities for improvement. [ABSTRACT FROM PUBLISHER]

The article presents a case study of a 28-year-old female with C1 esterase inhibitor deficiency who was referred to the hospital for removal of wisdom teeth. She had angioedema when she was two years old and experienced recurring angioedema episodes causing abdominal pain and hand swelling and was later diagnosed with sporadic onset C1 esterase inhibitor deficiency at age 16. She underwent prophylaxis with a bradykinin receptor B2 antagonist icatibant and perioperative and postoperative care.

Introduction: Lithium is a popular medication for bipolar disorder, but very little work has been done to study Asian patients with lithium poisoning. Methods: A total of 21 out of 7140 poisoned patients were referred for management of lithium poisoning between 2000 and 2009. Patients were stratified according to blood lithium level, that is mild-to-moderate (<2.5 mEq/L) or severe (≥2.5 mEq/L) poisoning. Demographic, clinical, and laboratory data were obtained for analysis. Mortality rates were also analyzed. Results: There were no significant differences between both groups for the baseline variables such as poisoning patterns, age, sex, smoking habit, alcohol consumption, or medical history of diabetes mellitus or hypertension (p > 0.05). Patients with severe poisoning had a greater distribution of severe neurological symptoms (mild/moderate/ severe: 11.1%/44.4%/44.4% versus 58.35%/16.65%/8.3%, p < 0.05), cardiovascular symptoms (66.6% versus 16.6%, p < 0.05), and renal impairment (urea nitrogen/creatinine: 27.1 ± 17.8/ 1.9 ± 1.3 mg/dL versus 14.1 ± 7.1/ 1.3 ± 0.6 mg/dL, p < 0.05) than patients with mild-to-moderate poisoning. Most patients were treated with saline diuresis (9 patients [100%] with severe poisoning versus 9 patients [75.0%] with mild-to-moderate poisoning, p > 0.05). Hemodialysis was initiated in 2 (22.2%) of 9 and 1 (8.3%) of 12 patients with severe and mild-to-moderate poisoning, respectively (p > 0.05). The treatment was successful and all patients recovered without chronic sequelae. Thus, these favorable outcomes were comparable to the data from other international Poison Centers. Conclusions: Given the excellent outcomes of detoxification protocols, patients undergoing lithium therapy must be closely monitored for its toxicity and treated immediately in case of poisoning. [ABSTRACT FROM AUTHOR]

Although prophylaxis is current practice, there are no randomized controlled studies evaluating preoperative antimicrobial prophylaxis in dental procedures in patients immunocompromised by chemotherapy or organ transplants. To evaluate prophylaxis in dental-invasive procedures in patients with cancer or solid organ transplants, 414 patients were randomized to receive one oral 500-mg dose 2 hours before the procedure (1-dose group) or a 500-mg dose 2 hours before the procedure and an additional dose 8 hours later (2-dose group). Procedures were exodontia or periodontal scaling/root planing. Follow-up was 4 weeks. No deaths or surgical site infections occurred. Six patients (1.4%) presented with use of pain medication > 3 days or hospitalization during follow-up: 4 of 207 (2%) in the 1-dose group and 2 of 207 (1%) in the 2-dose group (relative risk, 2.02; 95% confidence interval, 0.37-11.15). In conclusion, no statistically significant difference occurred in outcome using 1 or 2 doses of prophylactic amoxicillin for invasive dental procedures in immunocompromised patients. [ABSTRACT FROM PUBLISHER]

Provincial guidelines for HIV non-occupational postexposure prophylaxis (NPEP) were implemented on January 2005 in Alberta, Canada. Human immunodeficiency virus (HIV) NPEP was provided free of charge following approval by a medical officer of health. Between 1 January 2005 and 30 June 2007, 174 individuals were prescribed NPEP; 135 (78°h) were women with a median age of 24 years. Sexual assaults accounted for 68% of exposures. NPEP was completed in 49% of cases. Individuals who completed NPEP were less likely to have been exposed by sexual assault (P = 0.04) and more likely to have received HIV follow-up testing (P = 0.03). Individuals who received at least one HIV follow-up test were older (P = 0.03) and more likely to have been exposed percutaneously (P = 0.003). Those who received no follow-up testing were less likely to have filled an NPEP prescription (P = 0.0001). New strategies are required to improve follow-up of individuals receiving NPEP, especially younger persons or sexual assault survivors. [ABSTRACT FROM AUTHOR]

The article discusses the results of a study that examines bacterial bio-burden in Deep Vein Thrombosis (DVT) prophylaxis Intermittent pneumatic compression (IPC) garments after a single patient use. IPC garments from three different manufacturers were tested and compared with a sample of unused garments. After a single patent use, these garments reportedly have a significant amount of bio-burden which can cause healthcare associated infection (HCAI) and venous thromboembolism (VTE). It is recommended that these garments be for single patient use only.

Soft tissue involvement is an unusual presenting feature for children with meningococcal infection. We describe 2 children, 1 with conjunctivitis and another with a thyroglossal duct cyst abscess associated with Neisseria meningitidis, and review previous reports of these entities to emphasize the broad spectrum of meningococcal disease and pertinent aspects of treatment and of prophylaxis of contacts. [ABSTRACT FROM AUTHOR]

Twenty client-owned dogs diagnosed with gingivitis were studied over a 45-day period in order to investigate the effect of professional dental prophylaxis combined with the use of a topical mucoadhesive gel containing adelmidrol, an aliamide. A non-intrusive papillary-marginal-gingival index (PMGI) was measured at each assessment, while the gingivitis index (GI) was measured only at the beginning and end of the study. Compared to the control group, the treated dogs had a significant decrease (P < 0.005) in the average GI index during the course of the study. A significant reduction (P < 0.002) in the average PMGI index was observed in both groups 15-days following dental prophylaxis. However at 30 and 45-days following dental prophylaxis, the PMGI index values were significantly different (P < 0.005) from baseline only in treated dogs. These results suggest that the combined use of a mucoadhesive gel with dental scaling was able to improve the regression of gingival inflammation and lengthen the therapeutic benefits of dental scaling and polishing during a limited study period. [ABSTRACT FROM AUTHOR]

Despite the controversy about the risk of individuals developing bacterial endocarditis of oral origin, numerous Expert Committees in different countries continue to publish prophylactic regimens for the prevention of bacterial endocarditis secondary to dental procedures. In this paper, we analyze the efficacy of antibiotic prophylaxis in the prevention of bacteremia following dental manipulations and in the prevention of bacterial endocarditis (in both animal models and human studies). Antibiotic prophylaxis guidelines remain consensus-based, and there is scientific evidence of the efficacy of amoxicillin in the prevention of bacteremia following dental procedures, although the results reported do not confirm the efficacy of other recommended antibiotics. The majority of studies on experimental models of bacterial endocarditis have verified the efficacy of antibiotics administered after the induction of bacteremia, confirming the efficacy of antibiotic prophylaxis in later stages in the development of bacterial endocarditis. There is no scientific evidence that prophylaxis with penicillin is effective in reducing bacterial endocarditis secondary to dental procedures in patients considered to be "at risk". It has been suggested that there is a high risk of severe allergic reactions secondary to prophylactically administered penicillins, but, in reality, very few cases have been reported in the literature. It has been demonstrated that antibiotic prophylaxis could contribute to the development of bacterial resistance, but only after the administration of several consecutive doses. Future research on bacterial endocarditis prophylactic protocols should involve the re-evaluation of the time and route of administration of antibiotic prophylaxis, and a search for alternative antimicrobials. [ABSTRACT FROM AUTHOR]

Community-based mass prophylaxis is a core public health operational competency, but staffing needs may overwhelm the local trained health workforce. Just-in-time (JIT) training of emergency staff and computer modeling of workforce requirements represent two complementary approaches to address this logistical problem. Multnomah County, Oregon, conducted a high-throughput point of dispensing (POD) exercise to test JIT training and computer modeling to validate POD staffing estimates. The POD had 84% non-health-care worker staff and processed 500 patients per hour. Post-exercise modeling replicated observed staff utilization levels and queue formation, including development and amelioration of a large medical evaluation queue caused by lengthy processing times and understaffing in the first half-hour of the exercise. The exercise confirmed the feasibility of using JIT training for high-throughput antibiotic dispensing clinics staffed largely by nonmedical professionals. Patient processing times varied over the course of the exercise, with important implications for both staff reallocation and future POD modeling efforts. Overall underutilization of staff revealed the opportunity for greater efficiencies and even higher future throughputs. [ABSTRACT FROM AUTHOR]

It is difficult to support a standard of care for venous thromboprophylaxis after trauma when there is no convincing research that any of the currently used methods is consistently effective. Because many conclusions from the nontrauma literature have been misleadingly extrapolated to trauma patients, this review focuses exclusively on trauma articles. These articles present variable results. The rates of deep venous thrombosis and pulmonary embolism are widely different even among similar trauma populations. The heparin-unfractionated or low-molecular-weight and calf compression methods fail to show a reproducible effect in decreasing venous thromboembolic events. The current methods of venous thromboprophylaxis after trauma are inadequate and further research in this area is direly needed. [ABSTRACT FROM AUTHOR]

We present the British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis after sexual exposure (PEPSE) to HIV. This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of HIV infection after a potential exposure, and provides recommendations on when PEPSE would and would not be considered. Other areas included are the possible impact on sexual behaviour, cost-effectiveness, and issues relating to service provision. Throughout the document, consideration is given to the place of PEPSE within the broader context of HIV prevention strategies and sexual health. [ABSTRACT FROM AUTHOR]

The association between factor VII deficiency and cleft palate has never been described. The case of a child with cleft palate and factor VII deficiency who successfully underwent palatoplasty is described in this article. To allow surgical treatment, through maintenance of a normal prothrombin time, the patient was given 15 μg/kg of recombinant factor VIIa every 12 hours, starting 20 minutes before surgery and ending the third postoperative day. No abnormal perioperative bleeding was observed. Use of recombinant factor VIIa in bleeding prophylaxis or treatment is widespread. Doses are much higher in these cases. The reduction of dosage allows easier administration, especially in pediatric patients, without affecting drug efficacy. [ABSTRACT FROM AUTHOR]

Prior research has rarely examined the impact of ADA-recommended preventive practices on tooth retention. We hypothesized that better oral hygiene leads to increased tooth retention. We examined the association of cross-sectional and long-term assessments of preventive practices, as well as various combinations of hygiene practices, with tooth retention. Among 736 male participants in the VA Dental Longitudinal Study, we utilized cross-sectional and longitudinal self-reports of toothbrushing, dental floss use, annual prophylaxis, and combinations of such behaviors, and examined their association with clinically assessed numbers of teeth. Baseline and long-term hygiene behaviors (except brushing) were associated with an increased baseline number of teeth and decreased subsequent tooth loss. Use of multiple hygiene behaviors was associated with greater tooth retention, cross-sectionally and longitudinally. Adherence to ADA recommendations for preventive care leads to better oral health, and consistently practicing preventive behaviors over the long term confers greater benefits than doing so over the short term. [ABSTRACT FROM AUTHOR]

A synthetic pentasaccharide (SR90107/ORG31540) representing the antithrombin III (ATIII) binding sequence in heparin is under clinical development for the prophylaxis and management of venous thromboembolism. This pentasaccharide exhibits potent anti-factor Xa (AXa) effects (>730 IU/mg) and does not exhibit any anti-factor IIa (AIIa) activity. Previous reports have suggested that synthetic heparin pentasaccharides are resistant lo the digestive effects of heparinase I. To investigate the effect of heparinase I on the AXa activity of pentasaccharide SR90107/ORG31540, graded concentrations (1.25–100 μg/ml) were incubated with a fixed amount of heparinase I (0.1 U/ml). Heparinase I produced a strong neutralizing effect on this pentasaccharide, as measured by AXa activity. This observation led to further studies where high performance liquid chromatography (HPLC) analysis was employed to determine the potential breakdown products of the pentasaccharide. The experiment with the pentasaccharide included incubation (37°C) at 1 mg/ml and exposure [o graded concentrations of heparinase I (0.125–1 U/ml). After 30 min of incubation, the enzymatic activity was stopped by heat treatment and the mixture was analyzed using high performance size exclusion chromatography (HPSEC). Heparinase I concentration-dependent cleavage of the pentasaccharide was evident. The breakdown products exhibited a mass of 1,034 d and 743 d, respectively, suggesting the generation of a trisaccharide and a disaccharide moiety. The extinction of a disaccharide moiety in the UV region was high, indicating the presence of a double bond in this molecule. These data clearly suggest that pentasaccharide SR90107/ORG31540 is digestible by heparinase I into its two components. Furthermore, these data support the hypothesis that heparinase I can be used as a neutralizing agent for pentasaccharide overdose. Additionally, a highly methylated analog of the previously mentioned synthetic pentasaccharide, SanOrg34006, which has also been subjected to similar experiments, has shown complete resistance to the depolymerizing function of heparinase I; therefore, its use may be appropriate in chronic situations as a long-acting form of the pentasaccharide. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the prevalence of venous thromboembolism (VT) in current prophylactic practice with low-molecular-weight heparin (LMWH) among medical inpatients and to analyze associated risk factors for VT. A cross-sectional survey on five given days was conducted in the medical departments of a university hospital. The prevalence of prophylaxis and confirmed VT was measured. Risk markers for receiving high doses of LMWH and for VT under prophylaxis were assessed by logistic regression models. Of 1194 inpatients, 1.4% suffered VT. The mean proportion of patients with LMWH prophylaxis was 24% (range: 4–64%). The prevalence of VT was higher among inpatients receiving prophylaxis than among those patients not receiving prophylaxis (3.5% vs. 0.7%, p = 0.002). Under prophylaxis, independent risk markers for thrombosis were history of vein thrombosis (odds ratio [OR]: 4.03; confidence interval [95%CI]: 1.04–15.62) and age (OR: 1.08; 95%CI: 1.01–1.15). Two factors were independently associated with the prescription of high doses of LMWH: obesity was positively associated (OR: 7.50; 95%CI: 2.97–18.92; p < 0.0001) and respiratory insufficiency was negatively associated. In medical departments, current prophylaxis practice leads to many patients being given LMWH. LMWH doses and other preventive measures should be adapted in high-risk inpatients. [ABSTRACT FROM AUTHOR]

A re-audit of prescribing of post-exposure prophylaxis for HIV following sexual exposure in the Thames Valley demonstrated that an updated proforma has led to significant improvements in clinician-led outcomes, but had no impact on completion or follow-up rates. [ABSTRACT FROM AUTHOR]

A previous study of infection and morbidity in 400 women attending for termination of pregnancy (TOP) had shown that 32 (8%) harboured cervical Chlamydia trachomatis and 112 (28%) had anaerobic (bacterial) vaginosis (AV). Fiftythree per cent of the women with preoperative C. trachomatis had AV. Thirty of the 32 women with chlamydial infection were followed up and 19 (63%) of these developed post-abortion upper genital tract infection, 7 of whom needed readmission. In view of the high morbidity in women with chlamydial infection attending for TOP, anti-bacterial prophylaxis with metronidazole suppositories and oral oxytetracycline was introduced for women attending for suction termination of pregnancy (STOP). An audit of the clinical and financial benefits and/or losses was carried out. The audit of 1951 consecutive patients attending for STOP revealed that 132 (6.8%) had chlamydial infection with equivocal results reported in a further 2 patients. One hundred and eight of the 134 women responded to recall. Full genital tract infection screening was carried out in 105 of the 108 recalled patients of whom 5 had repeat positive cervical swabs for C. trachomatis, one had Trichomonas vaginalis, 24 had candidiasis and 17 had anaerobic vaginosis, none had gonorrhoea. Thirteen (12%) of the 108 women had pelvic infection as previously defined, none of whom required re-admission. At least £20,000 has been saved each year in our Trust following the introduction of pre-abortion chlamydial screening and universal antichlamydial and anti-anaerobe prophylaxis. The introduction of universal prophylaxis against C. trachomatis and AV has profoundly reduced morbidity in patients attending for TOP and has also resulted in substantial financial savings. [ABSTRACT FROM AUTHOR]

Our objectives were to evaluate tolerance and compliance of post-exposure triple therapy in health-care workers (HCWs) by retrospective observational study. Structured telephone interview of HCWs identified through data from antiretroviral prescribing centres. Twenty HCWs who received triple prophylaxis were identified over one year. Sixteen agreed to participate in the study. All but one source patient had documented HIV infection. Half HCWs were not aware of post-exposure therapy. Most HCWs received a zidovudine, lamivudine and indinavir combination. All completed at least 4 weeks of therapy. Only 50% received their first dosage less than 4 h after exposure. Nearly all experienced adverse events, mostly digestive (nausea and abdominal pain n=15) or psychological (anxiety and depression n=15), none resulting in therapy discontinuation. Most events occurred 2 to 7 days after therapy initiation. Most modified their sexual life with abstinence or condom use. Compliance was excellent. Half HCWs did not miss any tablet, 4 forgot one dosing a month and 4 one dosing a week. Follow up is over 6 months in all but one HCW. No HIV seroconversion has been observed to date. In France, post-exposure triple antiretroviral therapy is widely available 24 h a day in every emergency room but further training and development of HCWs is needed to decrease consulting time and increase referral to specialized physicians. Notable moderate adverse events, both physical and psychological are noted, however, compliance is excellent. [ABSTRACT FROM AUTHOR]

Antithrombin (AT) is one of the most important inhibitors of activated clotting enzymes. It is a progressive inhibitor of factors thrombin, Xa, IXa, and XIa. Any diminution of activity of AT in plasma causes an increased risk of thrombosis. It is, therefore, important to detect such deficiencies. Congenital defects of AT activity cause a tendency toward venous thrombosis and pulmonary embolism, frequently beginning between the ages of 10-15 years. In such cases a lifelong prophylaxis with oral anticoagulants is mandatory. In the case of surgery AT must be substituted to normal activity. Under this substitution an additional prophylaxis with low molecular weight heparin is also possible. In cases of pregnancy when oral anticoagulants cannot be given, substitution until delivery is necessary. Acquired AT deficiency in its most severe form is observed in consumption coagulopathy. In these cases it could be demonstrated that massive substitution of AT not only shortened the duration of this condition but was also frequently lifesaving. Antithrombin concentrates are, therefore, of considerable importance under certain conditions. Antithrombin deficiency is also found in the nephrotic syndrome due to massive losses of proteins. A diminished production of AT is observed in severe liver diseases. In these cases there is also a diminution of procoagulant factors and platelets resulting in a tendency toward a bleed instead of thrombosis. [ABSTRACT FROM AUTHOR]

The aim of this retrospective and prospective study was to evaluate the efficacy of the authors' newly devised lithotomic position (NDLP) for use during surgery to prevent intraoperative calf vein thrombosis (CVT). From their concern about development of CVT during rectal cancer surgery, they reviewed 84 patients who were operated on in a traditional lithotomic position (TLP) retrospectively and examined prospectively 102 patients operated on in an NDLP. In the TLP group, 8 patients (9.5%) developed CVT; however, none of the NDLP group suffered from CVT, the difference being significant (P<0.01). From this study, the effectiveness and usefulness of the NDLP are strongly emphasized to prevent intraoperative CVT during rectal cancer surgery. [ABSTRACT FROM AUTHOR]

Thirty children with simple febrile convulsions were treated with sodium valproate following their second convulsion. Twenty-two of the 30 (73%) had no further convulsions during the one-year period of observation corn pared with 17 of 28 in the control group (61%). This was not a statistically significant difference. Side effects attributed to sodium valproate treatment were noted in 7 patients (23%), although 4 of these showed only mild transient gastrointestinal symptoms at high dosage. The study did St confirm any advantage in the use of sodium valproate as a prophylaxis for febrile convulsions, although compliance was good and significant side effects infrequent. [ABSTRACT FROM AUTHOR]

The article presents a case of a nine-year-old child who, following unsuccessful prophylaxis with oral penicillin for a dental procedure, developed endocarditis due to a strain of Streptococcus viridans resistant to penicillin. Bacterial endocarditis remains a formidable diagnostic and therapeutic problem for clinicians. New recommendations and standards for endocarditis prophylaxis for patients at risk may reduce the occurrence of cases previously attributed to oral prophylaxis failure. However, there still remains the unresolved problem of the management of endocarditis due to penicillin-resistant Streptococcus viridans. Streptococcus viridans still accounts for 45 to 50 percent of all cases and between 5 to 10 percent of all clinical isolates of Streptococcus viridans from patients with bacterial endocarditis may be relatively resistant to penicillin. In the face of penicillin resistance, additional considerations for workup, including microbiological assays for antimicrobial synergism become necessary in the selection of a therapeutic regimen.

The role of Streptococcus mutans in the initiation of dental caries has been recognized and attributed, at least in part, to its ability to colonize the tooth surface. Therefore, factors which prevent S. mutans attachment to hydroxy-apatite (HA) are of considerable interest for the prophylaxis of this infectious disease. Chitosan, a chitin derivative by N-deacetylation, is an interesting candidate in this respect, since it stimulates the ordered regeneration of oral soft tissues, prevents the deleterious action of organic acid, and exhibits bactericidal action against several pathogens. In the present work, the efficacy of a low-molecular-weight chitosan (LMWC) and its derivatives N-carboxymethyl chitosan (NCMC) and imidazolyl chitosan (IMIC) in preventing S. mutans attachment to HA beads was assessed. The effects of chitosan on both sucrose-dependent and -independent adherence were evaluated. In both cases, when saliva-coated or uncoated HA beads were treated with any of the chitosans, a reduction in S. mutans adsorption ranging from 47 to 66% was observed. When HA beads were coated with saliva after the treatment with chitosan, neither carbohydrate caused a statistically significant reduction in S. mutans adsorption, suggesting that saliva deposition restores HA binding properties. Bacteria grown in the presence of chitosan subminimal inhibitory concentrations (sub-MICs) ranging from 12 to 500 µg mL-1 adsorbed poorly to HA and exhibited a lower affinity toward xylene than untreated controls. In the presence of chitosan sub-MICs up to 60 µg mL-1, an increase in the percentage of detached bacteria from two- to nine-fold was observed. The desorptive effect of chitosan was weaker when S. mutans had adhered to saliva-coated HA in the presence of sucrose. These results demonstrate that the presence of minor amounts of modified chitosans prevents S. mutans adsorption to HA and suggest that colonization of the tooth surface might be impaired by the use of toothpastes, mouthrinses, or chewing gums containing any of the tested polysaccharides. [ABSTRACT FROM AUTHOR]

The hypotheses to be tested were: (i) that chewing sugar-free gum frequently and for long periods would be associated with higher amounts of supragingival calculus, and (ii) that there would be no site-specificity of calculus deposition on the lingual surfaces of the 6 lower anterior teeth. Subjects, 436 in Glasgow and 191 in Winnipeg, were scored for calculus at mesial, lingual, and distal sites on the lingual surface of each of the 6 lower anterior teeth, by the Volpe-Manhold method. They also answered questions on the time since the last prophylaxis, the frequency of gum chewing, the type of gum chewed, and the length of a typical gum-chewing episode. A subset (233) of the Glasgow subjects were scaled and re-scored for calculus 3 months later. When the data for the logarithmic transformations of the initial calculus scores were subjected to stepwise multiple-regression analysis, the only factor which correlated significantly with initial calculus scores in both cities was the time since the last prophylaxis. In the Glasgow subjects scored 3 months after a prophylaxis, there was a negative correlation between chewing sugar-free gum and calculus scores, whereas in the Winnipeg subjects, age and the chewing of sucrose-containing and sugar-free gum were positively correlated with calculus scores. Thus, the results were contradictory with respect to the first-tested hypothesis. The calculus distribution patterns were very similar in the subset of Glasgow subjects and the Winnipeg subjects, with the amounts on the lateral incisors and canines averaging 70.2% and 44.5%, respectively, of those on the central incisors. Thus, the second hypothesis was disproved. [ABSTRACT FROM AUTHOR]

This report reviews the current status of various topical fluoride systems commonly used for caries prevention; these systems include professional fluoride applications, prophylaxis pastes, varnishes, rinses, gels, and dentifrices. Although the cariostatic benefits of professional applications are well-established from early studies, the magnitude of benefit relative to other preventive measures needs to be re-assessed under current conditions. Significant cariostatic benefits from fluoride prophylaxis pastes remain to be established, as does the relative efficacy of fluoride varnishes in comparison with other fluoride measures. The established cariostatic activity of fluoride rinses with supervised usage needs confirmation under normal home usage conditions. There is inadequate evidence to justify either increasing or decreasing the concentration of fluoride in conventional dentifrices whose efficacy is well-established. Based on limited clinical data and supportive laboratory data, fluoride appears to be effective for preventing root-surface caries. [ABSTRACT FROM PUBLISHER]

Most animal models for the study of calculus accumulation and control currently use rodents or dogs. In an effort to overcome limitations inherent in the use of these species, we investigated calculus formation in domestic ferrets, a species used by King et al. in the 1940's and 1950's. Ferrets are much smaller than dogs, and, unlike rodents, can be scored while alive. In this study, we examined the kinetics of calculus formation in female ferrets fed with moist canned cat food either plain or supplemented with sucrose-and two combinations of mineral salts. An additional group given supplemented cat food was treated twice daily with regular Crest toothpaste. Animals were sedated with a 1:1 mixture of ketamine and xylazine solutions and given a mechanical prophylaxis prior to the trial period, then scored for area and extent of calculus accumulation at two, four, six, and eight weeks thereafter. The data showed that the mineral-supplemented groups accumulated calculus at a significantly faster rate than the unsupplemented or dentifrice-treated groups, but the differences were no longer significant at eight weeks. This demonstrated that the ferret is a suitable model for the study of calculus, that dietary mineral content influenced calculogenesis, and that the application of regular dentifrice initially slowed, but did not prevent, calculus accumulation. [ABSTRACT FROM AUTHOR]

Dental prophylaxis with APF gels (1.23%) may cause gastric distress as a side-effect. This gastric irritation is probably due to a direct toxic effect of fluoride (F), swallowed in conjunction with the treatment, on the gastric mucosa. The aim of the present study was to investigate whether--and to what extent--a dental treatment with 3 g of a 0. 42%- F gel could affect the gastric mucosa due to inadvertent swallowing of the gel. Ten subjects underwent a control gastroscopy, and two weeks later, a second gastroscopy was performed two h after a F gel treatment. During the gastroscopy, the mucosa was examined and the injuries graded according to an arbitrary scale. Four biopsies of the antral and corpus regions of the stomach were taken and evaluated histologically. The mean (± SD) amount of F retained after the application was 5.1 ± 2.1 mg, i.e., 40% of the applied amount of F. Petechiae and erosions were found in the mucosa in seven of the ten patients. The histopathological evaluation revealed changes in nine of ten patients, with the surface epithelium as the most affected component of the mucosa. The present study clearly shows that a treatment with a F gel of rather low F concentration may result in injuries to the gastric mucosa. The importance of current recommended guidelines so that the amount of F swallowed during a gel application can be minimized is emphasized. From a toxicological standpoint, the use of a low-F gel instead of a 1.23%-F gel in small children is recommended for avoidance of adverse gastric effects. [ABSTRACT FROM AUTHOR]

The composition of pooled starved plaque fluid from six population samples, grouped according to age (8-11, 12-16, 8-17, 18-22 years) and caries status (caries-free, CF, DMFS = 0; caries-susceptible, CS, DMFS > 10), was determined by means of ion chromatography. Prior to plaque collection, all subjects abstained from oral hygiene for 48 hours and fasted overnight. In addition, selected subjects also received a dental prophylaxis one week prior to plaque collection. Plaque samples from each group were pooled under mineral oil and centrifuged at 15, 000 g (ambient temperature) for 45 minutes. Supernatants were then analyzed for organic acids, inorganic anions, and mono- and divalent cations. Plaque fluid samples from CF and from the CS subgroups were also titrated with standard HC1 for exploration of the inherent buffer capacity. The ions Na + NH4+, K+, Ca2+, Mg2+, Cl-, phosphate, and carbonate were present in all samples analyzed. Formic, acetic, propionic, butyric, and trace amounts of isobutyric and isovaleric acids were detected, with acetic and propionic acids comprising between 85 and 94% of the total acids. Little (< 1 mmol/L) to no succinic or lactic acid was detected in starved plaque fluid. No apparent difference was detected in the composition and saturation status of pooled starved plaque fluid from CF and CS individuals. These results suggest that caries susceptibility is not necessarily correlated with the plaque fluid composition of pooled starved plaque. In addition, no apparent difference in the inherent buffer capacities of these samples could be detected, consistent with the noted similarities in composition. It was also apparent from the titration studies that a significant buffering component is missing from our analyses; this missing component appears to be an effective buffer above pH 6. [ABSTRACT FROM AUTHOR]

The composition of pooled resting plaque fluid from 10 population samples, grouped according to age (8-11, 14-17, 18-25 years) and caries status (caries-free, CF, DMFS = 0; caries-susceptible, CS, DMFS > 10), was determined by means of ion chromatography. Subjects received a dental prophylaxis one week prior to plaque collection, abstained from oral hygiene for 48 hours, and did not eat or drink for at least one hour prior to plaque collection. Plaque samples from each group were pooled under mineral oil and centrifuged (15, 000 g) for 45 minutes at ambient temperature. Supernatants were analyzed for organic acids, inorganic anions, mono- and divalent cations, and pH value. The ions Na+, NH4+, K+, Ca2+, Mg2+, Cl-, and phosphate were present in all samples. Acetic and propionic acids were predominant, comprising over 75% of the acid (anions) present under resting conditions. Succinic, lactic, formic, and butyric acids were present in lower concentrations. Within each age group, the mean values for pH and NH4+ concentration were higher in the caries-free group; the differences between mean values (CF: p11 6.35; NH4+, 52 mmol/L; CS: pH, 5.85; NH4+, 37 mmol/L) were found to be statistically significant (p < 0.05) when all data for the CF and CS groups were combined. Significantly higher concentrations of Mg2+ and butyric acid were also found for the combined CF data. Concentrations of all other constituents were similar. Calculations indicate that plaque fluid is supersaturated with respect to enamel mineral and dicalcium phosphate dehydrate, with a significantly higher degree of saturation with respect to enamel mineral in the CF group. These results suggest that resting plaque fluid from CF individuals has a greater remineralization potential than that from CS individuals. It is suggested that the noted difference in saturation status is related to differences in plaque pH, resulting from differences in NH3 production, which may reflect the presence of different bacterial species and residual energy sources. [ABSTRACT FROM AUTHOR]

A 34-month clinical investigation of root caries was conducted using a hospitalized, chronically-ill population. Forty-five subjects with 150 caries-free surfaces were observed for at least 12 consecutive months. Clinical measurements included diagnosis of new root and coronal caries, gingival inflammation, pocket depth, recession, and distance of new lesions from the gingival margin. The overall root caries attack rate was1.90 lesions per 100 person-months at risk, with the greatest rate occurring during the first year of study. Mesial and facial surfaces accounted for 84% of all new lesions. Sixteen subjects accounted for 26 new lesions; nine subjects had two or more new lesions. Subjects with new root lesions were found to have lower enamel caries experience but higher root caries experience at baseline and higher scores for gingival inflammation, pocket depth, and recession compared with those who did not develop root caries. [ABSTRACT FROM AUTHOR]

Clinically relevant values for revolutions per minute (rpm), time, and load should be used when one evaluates effects of abrasive slurries on teeth. However, in the past, these variables have not been measured in vivo to determine clinical means. This study describes an instrument and computer software which monitored rpm, time, and load used by 29 clinicians during routine oral prophylaxes performed on 76 patients. Grand means and standard deviations determined for the three variables were: rpm, X̅ = 2571 (s = 739); time per tooth surface, X̅ = 4.5 sec (s = 2.9); and load, X̅ = 145 g (s = 66). Mean rpm, time, and load used on facial and lingual surfaces of the 32 teeth were also determined. Statistical tests showed that rpm was not altered significantly by tooth location, surface, or type and amount of deposit, but time was affected significantly by tooth location, surface, and amount of calculus; load was affected by tooth location, surface, and amount and intensity of stain. [ABSTRACT FROM AUTHOR]

The fluoride (F) uptake from two commercial prophylaxis pastes and a newly formulated prophylaxis paste was compared. The enamel fluoride uptake of 26 extracted sound human molars was measured using an acid etch biopsy method. The F uptakes in ppm (mean ± SEM) for the control prophy pastes (C), Zircate treatment paste (Z), an APF paste (Nupro, A), and a new experimental paste (N) were 1145 ± 65, 1245 ± 72, 1857 ± 296, and 1841 ± 321, respectively. The enamel biopsy depths in μm (mean ± S.D.) for the control, Zircate, APF pastes, and Newpaste were 6.64 ± 1.75, 7.4 ± 2.32, 6.55 ± 2.23, and 7.69 ± 1.80. The Newpaste appeared to give a significantly higher fluoride uptake than Zircate and control pastes, but was very similar to an APF paste. [ABSTRACT FROM AUTHOR]

Whole saliva from patients with gingivitis or marginal periodontitis was analyzed for both the number of epithelial cells and leukocytes and the protease activities. Significant correlations were observed between protease activities and the number of epithelial cells, but not of leukocytes. Also, it was found that oral prophylaxis reduced the numbers of epithelial cells and leukocytes and the protease activities in the whole saliva. [ABSTRACT FROM AUTHOR]

A sodium-potassium aluminum silicate cleaning and polishing agent was compared with conventional prophylaxis abrasives and was found to he highly compatible with fluoride. When formulated into a fluoride prophylaxis paste, especially with stannous fluoride, a larger reduction in enamel solubility and greater fluoride uptake were obtained than with representative commercial prophylaxis pastes. [ABSTRACT FROM AUTHOR]