Search

Objective To compare the effect of two newly formulated chlorhexidine ( CHX) and cetylpyridinium chloride ( CPC) mouthrinses after scaling and root planing ( SRP) in terms of clinical, microbiological, patient-based variables and adverse events, with a positive control with the same active components, already marketed and tested. Methods A pilot, randomized clinical trial, double-blind, parallel design with 1-month follow-up was conducted. Chronic periodontitis patients requiring non-surgical periodontal therapy were enrolled and randomly assigned to: (i) SRP and test-1 (new reformulation: 0.12% CHX and 0.05% CPC); (ii) SRP and test-2 (new formulation: 0.03% CHX and 0.05% CPC); or (iii) SRP and positive control (commercial product: 0.12% CHX and 0.05% CPC). All variables were evaluated at baseline and 1 month after SRP. Quantitative variables were compared by means of anova or Kruskal-Wallis test and qualitative variables by chi-square or McNemar tests. Results Thirty patients (10 per group) were included. After 1 month, there were significant differences among groups in plaque levels ( P = 0.016) as test-1 showed less sites with plaque than test-2 (31.15% [standard error- SE 2.21%] versus 49.39% [ SE 4.60%), respectively). No significant differences were found for global patient perception of the product or in adverse effects. Test groups showed better results in levels and proportions ( P = 0.022) of Capnocytophaga spp. Conclusions Within the limitations of this pilot study, it can be concluded that the newly formulated 0.12% CHX and 0.05% CPC mouthrinse showed larger plaque level reductions, without showing more adverse effects, when compared to the other two mouthrinses, after SRP. [ABSTRACT FROM AUTHOR]

Background and Objective Bacteria in the oral cavity grow in the form of biofilms; these structures are subject to constant saliva or gingival crevicular fluid flow conditions. The aims of this study were: (i) to develop and to characterize an in-vitro biofilm model with oral bacteria growing under flow and shear conditions; and (ii) to demonstrate the usefulness of the model for evaluating the activity of three antiplaque agents. Material and Methods We used a bioreactor to grow the oral bacteria Streptococcus oralis, Actinomyces naeslundii, Veillonella parvula, Fusobacterium nucleatum, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis under planktonic conditions. Biofilms were established using a modified Robbins device on hydroxyapatite ( HAP) discs. Three- to 7-d-old biofilms were analysed using culture methods, scanning electron microscopy, Live/ Dead staining and fluorescence in-situ hybridization (confocal laser scanning microscopy). Finally, we assessed the antimicrobial activity of three mouthrinses [0.12% chlorhexidine ( CHX), 0.12% chlorhexidine and sodium fluoride ( CHX+ Na F) and 0.12% chlorhexidine and 0.05% cetylpyridinium chloride ( CHX+ CPC)] using a planktonic test (short interval-killing test) and in our 4-d biofilm model. Results The viable cell counts showed that each species was consistently found in the biofilms throughout the study. The architecture and cell distribution were similar to those described for biofilms in situ, with the exception of a thin layer of living cells that was found close to the HAP. The effectiveness test of the mouthwashes demonstrated that cells in biofilms showed more tolerance compared with planktonic cells. Moreover, it was observed that in 4-d biofilm formed in vitro, CHX+ CPC caused significantly higher mortality compared with CHX ( p = 0.003) and CHX+ Na F ( p < 0.001). Conclusion Our results suggest that we have a highly reproducible system for multispecies oral biofilm formation and that it is a useful tool for assessing antibacterial molecules before their clinical evaluation. It also has great potential to be used in basic research on supragingival and subgingival biofilms. [ABSTRACT FROM AUTHOR]

Background and Objective Studies performed over the last 15 years have suggested that periodontal diseases may be associated with adverse pregnancy outcomes. However, this association has not been found in all populations. The aim of this study was to evaluate whether periodontal status and the presence of specific periodontal pathogens may influence the incidence of adverse pregnancy outcomes. Material and Methods Pregnant women were clinically examined before 26th week of gestation, and divided in two groups: non-periodontitis and periodontitis. Microbial samples were obtained in the periodontitis group and processed by anaerobic culturing. After delivery, data on the pregnancy outcome were taken; mother's socio-demographic and risk factors were obtained at inclusion. Simple and multiple regression analysis were performed. Results One hundred and seventy women were included in the study (116 non-periodontitis and 54 with periodontitis). The incidence of preterm ( PTB) and low-birth weight ( LBW) was 2.94% and 3.53%, respectively. Periodontal status did not show any association with adverse pregnancy outcomes. The presence of Eikenella corrodens was significantly related to PTB ( p = 0.022) and the presence Capnocytophaga spp. was related to LBW ( p = 0.008). The multivariate analyses showed a significant association between PTB and newborn weight and counts of E. corrodens. Maternal health and counts of E. corrodens were significantly associated with PTB or LBW. Conclusion The clinical periodontal condition was not associated with adverse pregnancy outcomes in a Spanish Caucasian population with medium-high educational level. The presence and counts of E. corrodens and the presence of Capnocytophaga spp. showed a significant association with PTB and LBW, respectively, in the bivariate and/or multivariate model. [ABSTRACT FROM AUTHOR]

Background and Objectives One of the major disadvantages of DNA-based microbial diagnostics is their inability to differentiate DNA between viable and dead microorganisms, which could be important when studying etiologically relevant pathogens. The aim of this investigation was to optimize a method for the selective detection and quantification of only viable Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis cells by combining quantitative real-time polymerase chain reaction (q PCR) and propidium monoazide ( PMA). Material and Methods Three different concentrations of PMA (10, 50 or 100 μ m) were added to suspensions of 106 (CFU)/mL of viable/dead A. actinomycetemcomitans and P. gingivalis cells. After DNA isolation, q PCR was carried out using specific primers and probes for the tested bacteria. PMA was further tested with different mixtures containing varying ratios of viable and dead cells. The efficacy of PMA to detect viable/dead cells was tested by analysis of variance. Results For these specific bacterial pathogens, 100 μ m PMA resulted in a significant reduction of q PCR amplification with dead cells (106 CFU/mL), while with viable cells no significant inhibition was detected. PMA was also effective in detecting selectively viable cells by q PCR detection, when mixtures of varying ratios of viable and dead bacteria were used. Conclusions This study demonstrated the efficiency of PMA for differentiating viable and dead A. actinomycetemcomitans and P. gingivalis cells. This method of PMA-q PCR may be useful for monitoring new antimicrobial strategies and for assessing the pathogenic potential of A. actinomycetemcomitans and P. gingivalis in different oral conditions when using molecular diagnostic methods. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Smilax canariensis is an endemic species of the Canary Islands, popularly known as “Zarzaparrilla sin espinas”. The rhizome, leaves and stem of this species has wide use in folk medicine practice on the islands, where they are habitually employed as diuretic. Aim of the study: In this paper we report on the diuretic activity in experimental animals of several fractions of the methanol extract of this species. Materials and methods: Four fractions of the methanol extract of the rhizomes, leaves and stem of Smilax canariensis (50 and 100mg/kg), Furosemide and Hydrochlorotiazide (10mg/kg), were orally administered to laboratory animals to evaluate their diuretic activity. Water excretion rate, pH, conductivity, and content of Na+, K+ and Cl− were measured in the urine of saline-loaded mice. Results: All the studied extracts showed an interesting increase of the diuresis, although the n-buthanol (27%; p <0.05) and ethyl acetate extract (35%; p <0.01), at 100mg/kg p.o., showed the most interesting diuretic activity, which suggested that this diuretic effect is associated with the compounds contained in the fractions of intermediate polarity (ethyl acetate and n-butanol), decreasing in the most extreme apolar and polar sub-extracts (dichloromethane and methanol: water respectively). The increase in diuresis produced by these two extracts was very close to the values of Hydrochlorothiazide (32%) or Furosemide (39%), used as reference diuretics. Conclusions: These data, together with previous results on the aqueous and methanol extracts, reaffirm assertions made regarding the effectiveness of the extracts of this plant against urinary pathologies in the Canary Islands folk medicine. [Copyright &y& Elsevier]

van Winkelhoff AJ, Herrera D, Oteo A, Sanz M. Antimicrobial profiles of periodontal pathogens isolated from periodontitis patients in the Netherlands and Spain. J Clin Periodontol 2005; 32: 893–898. doi: 10.1111/j.1600-051X.2005.00782.x. © Blackwell Munksgaard, 2005. Antimicrobial resistance of periodontal pathogens towards currently used antibiotics in periodontics has been investigated in a previous study. Microbial resistance in the periodontal microflora was more frequently observed in Spanish patients in comparison with Dutch patients. The aim of the present study was to compare antimicrobial susceptibility profiles of five periodontal bacteria isolated from periodontitis patients in Spain and in the Netherlands. Subgingival plaque samples from adult patients with periodontitis were collected and cultured on selective and non-selective plates. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Micromonas micros were isolated and used for minimal inhibitory concentration tests using the Epsilometer (E-test) technique. Eight different antibiotics were tested on all bacterial isolates. MIC50 and MIC90 values for each antibiotic and each species were determined and the percentage of resistant strains was calculated. Significantly higher MIC values were noted in Spanish strains of F. nucleatum for penicillin, ciprofloxacin, of P. intermedia for penicillin, amoxicillin and tetracycline, of M. micros for tetracycline, amoxicillin and azithromycin, and of P. gingivalis for tetracycline and ciprofloxacin. Based on breakpoint concentrations, a higher number of resistant strains in Spain were found in F. nucleatum for penicillin, amoxicillin and metronidazole, in Prevotella intermedia for tetracycline and amoxicillin, and in A. actinomycetemcomitans for amoxicillin and azithromycin. Resistance of P. gingivalis strains was not observed for any of the antibiotics tested both in Spain and the Netherlands. Differences exist in the susceptibility profiles of periodontal pathogens isolated from periodontitis patients in Spain and in the Netherlands. This implicates that antibiotic susceptibility testing is necessary to determine efficacy of antimicrobial agents. Also, clinical studies with antibiotics should take these differences into account. The information from the present study indicates that it may not be possible to develop uniform protocols for usage of antibiotics in the treatment of severe periodontitis in the European Union. [ABSTRACT FROM AUTHOR]

The relationship between the social structure of urban spaces and the evolution of the COVID-19 pandemic is becoming increasingly evident. Analyzing the socio-spatial structure in relation to cases may be one of the keys to explaining the ways in which this contagious disease and its variants spread. The aim of this study is to propose a set of variables selected from the social context and the spatial structure and to evaluate the temporal spread of infections and their different degrees of intensity according to social areas. We define a model to represent the relationship between the socio-spatial structure of the urban space and the spatial distribution of pandemic cases. We draw on the theory of social area analysis and apply multivariate analysis techniques to check the results in the urban space of the city of Malaga (Spain). The proposed model should be considered capable of explaining the functioning of the relationships between societal structure, socio-spatial segregation, and the spread of the pandemic. In this paper, the study of the origins and consequences of COVID-19 from different scientific perspectives is considered a necessary approach to understanding this phenomenon. The personal and social consequences of the pandemic have been exceptional and have changed many aspects of social life in urban spaces, where it has also had a greater impact. We propose a geostatistical analysis model that can explain the functioning of the relationships between societal structure, socio-spatial segregation, and the temporal evolution of the pandemic. Rather than an aprioristic theory, this paper is a study by the authors to interpret the disparity in the spread of the pandemic as shown by the infection data.

Aim: To identify loci associated with stages III/IV, grade C periodontitis (PIII/IV-C) through a genome-wide association study (GWAS)., Materials and Methods: 441 Caucasian Spanish PIII/IV-C cases from the SEPA Network of Research Clinics and 1141 controls from the Banco Nacional de ADN were genotyped with "Axiom Spain Biobank Array," which contains 757836 markers, including rare and low-frequency Spanish variants. The analysis of the individual association and subsequently the gene-level analysis with Sequence Kernel Association Test (SKAT) were carried out adjusting for age, sex and PC1 covariates. Pathway Analysis was additionally performed with Ingenuity Pathway Analysis (IPA) software on the top associated genes., Results: In the individual analyses, no genome-wide significant signals were detected. However, 8 SNPs of 8 loci reached suggestive evidence of association with PIII/IV-C, including FAT3 rs35709256, CSNK1G2 rs4807188, MYH13 rs2074872, CNTN2 rs116611488, ANTXR1 rs4854545, 8p23.2 rs78672540, ANGPT1 rs13439823 and PLEC rs11993287 (p < 5 × 10 -6 ). SKAT analysis identified other interesting signals at CNTN2, FBXO44, AP1M2, RSPO4, KRI1, BPIFB1 and INMT, although their probability does not exceed the multiple-test correction. IPA indicated significant enrichment of pathways related to cAMP, IL-2, CD28, VDR/RXR and PI3K/Akt.  CONCLUSIONS: GWAS found no SNPs significantly associated with PIII/IV-C., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To evaluate radiographic bone level (RxBL) at dental implants and its associated factors in Spain., Material and Methods: This cross-sectional study was performed by a network of sentinel dentists from regions of Spain. RxBL was defined as the distance from the implant shoulder to the first clearly visible contact between the implant surface and the bone. Radiographic measurements were performed by two trained and experienced periodontists. Implant and patient data were also collected. Descriptive, bivariate, discriminative and multivariate analyses were done., Results: A total of 49 sentinel dentists provided data 275 patients. Mean RxBL from 474 implants (5-13 years) was 1.87 mm (range: 0.00-13.17 mm). Statistically significant associations between RxBL and clinical output variables (bleeding on probing, oedema, plaque, probing depth, suppuration, keratinized tissue) were found. In the multiple regression analysis, statistically significant associations for RxBL were found for smoking habit, implant diameter, years of follow-up and type of prosthesis (p < 0.01)., Conclusions: Peri-implant RxBL ranged from 0 to 13.17 mm. It was significantly associated with clinical output variables and with some potentially predictor variables, at patient- (smoking >10 cigarettes/day) and implant- (diameter, years of follow-up, Toronto bridge) levels., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To study whether there is an association between caries and periodontitis in a representative sample from employed Spanish adults., Materials and Methods: This cross-sectional study is part of a wide epidemiological survey (WORALTH, Workers' ORAL healTH). Oral examination was carried out in 5130 dentate subjects. Periodontal status was assessed by clinical attachment level (CAL) and Community Periodontal Index (CPI) in index teeth. For caries, all teeth were classified as healthy, decayed (D), filled (F), or missed (M), and DMFT index and prevalence of cavitated caries were calculated. ANOVA, Chi-square tests, and regression models were performed., Results: DMFT increased with CAL values, being 7.8, 9.6, and 10.5 for CAL 0-3 mm, 4-5 mm, and ≥ 6 mm, respectively. After adjustment for confounders, subjects with CPI ≥ 3 showed an odds ratio of 1.6 (95% confidence interval (CI) [1.3; 1.8]; p < 0.001) for presenting cavitated caries, and patients with CAL ≥ 6 mm had 0.8 higher mean DMFT (95% CI [0.2; 1.5]; p = 0.015), and 0.3 higher mean DFR (95% CI [0.2; 0.5]; p < 0.001) than those with CAL < 6 mm., Conclusions: The presence of CAL ≥ 6 m mm was associated with an increased DMFT and DFR, and the presence of CPI ≥ 3 was associated with a higher prevalence of cavitated caries in this representative sample., Clinical Relevance: There is a tendency to present higher prevalence of dental caries among patients with periodontitis. Therefore, common preventive measures in dentistry, such as oral hygiene practices, should ideally include actions aimed to prevent at the same time dental caries and periodontitis.

Introduction: Evidence of an association between periodontitis and MetS (metabolic syndrome) remains controversial. The objective of this study is to evaluate the association between periodontitis and MetS in a cross-sectional population survey., Material and Methods: WORALTH (Workers' ORAL healTH) Study is a cross-sectional survey, conducted on a representative sample of the Spanish employed population, including 5154 participants. An oral examination following the World Health Organization (WHO) criteria evaluated the periodontal status using the Community Periodontal Index (CPI) and Clinical Attachment Levels (CAL). Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and MetS, and its individual components., Results: Participants presenting a CPI = 4 were more likely to have MetS than subjects with CPI < 4 [odds ratio, OR = 1.41; 95% confidence interval (CI) 1.10-1.81; p < 0.001]. High blood pressure was the component with stronger association with periodontal status (OR = 1.94 for CAL ≥6 mm; 95% CI 1.49-2.53; p < 0.001). After stratifying for sex, the association was higher in women (OR = 2.20 for CPI = 4; 95% CI 1.31-3.62; p < 0.001). Non-metabolically healthy subjects, obese or not, presented a worse periodontal condition., Conclusion: Severe periodontitis (CPI = 4) was associated with MetS in a representative sample of the Spanish employed population. This association seems to be independent of body mass index and other potential confounders., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Objective: Use of self-reported questionnaires in Dentistry may be useful to estimate the prevalence of periodontitis in epidemiological studies. This study aims to assess the accuracy of self-reporting for predicting the prevalence of periodontitis in a Spanish population participating in a diabetes incidence study., Materials and Methods: Data were collected from 231 patients participating in the Di@bet.es study. Eight questions about periodontal health were included in a health patient-reported questionnaire. The outcomes from self-reporting were validated against a full-mouth periodontal examination. Multivariable logistic regression predictive modeling was used to determine the sensitivity, specificity, and area under the receiver operator characteristic curve (AUROCC)., Results: Self-reported gum health, loose teeth, tooth appearance, and use of dental floss were associated with different definitions of severe periodontitis. Correlations between responses to the questions were weak. The question "Do you think you might have gum disease?" combined with demographic and well-established risk factors resulted in an AUC value of 0.75, sensitivity of 75.2%, and specificity of 60.6% for severe periodontitis. The answer to 4 questions combined with age, educational level, smoking status, and tooth loss was 76.4% sensitive and 63.5% specific, with an AUC of 0.75 in predicting prevalence of ≥25% of teeth with probing pocket depth (PPD) ≥6 mm., Conclusion: Predictive models, combining self-reporting on oral health status with demographic and risk factors, were useful for estimating the prevalence of severe periodontitis in the Spanish population., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To examine the association between periodontitis, diabetes, and prediabetes, assessed by fasting plasma glucose (FPG)., Materials and Methods: Workers' Oral Health Study is a cross-sectional survey conducted on a representative sample of the Spanish employed population including 5154 participants (59.5% men, aged 16-65). Examination of periodontal status assessed Community Periodontal Index (CPI) and clinical attachment levels (CAL). Biochemical determinations included fasting plasma glucose (FPG), triglycerides, and total cholesterol. Logistic regression analysis with adjustment for potential confounders was used to evaluate the association between periodontitis and abnormal glucose regulation., Results: Ninety-five participants (2.2%) of the study population had diabetes, while 373 (8.8%) presented prediabetes. Prediabetes was not associated with CPI or CAL in fully adjusted multivariate logistic regressions models. Diabetes was significantly associated with subjects having a CPI 4 after adjustment for potential confounders (odds ratio OR = 1.9, 95% confidence interval (CI) 1.1-3.1). This association was stronger in subjects < 45 years (OR = 4.0, 95% CI 1.2-12.7)., Conclusion: Periodontitis was associated with diabetes mellitus, but not with prediabetes, in a representative sample of the Spanish employed population. The association was stronger for younger subjects, which emphasizes the need for early detection of diabetes in younger patients affected by periodontitis, particularly because periodontal therapy may help to improve glycemic control., Clinical Relevance: Periodontitis is associated with diabetes mellitus, having at the same time a negative effect on glycemic control. It is important to develop proper early diagnosis strategies for both conditions, particularly in young male adults.

Objective: This study was aimed to compare the presence and amounts of bacteremia induced by interdental brushing in periodontally healthy (H) and periodontitis (P) individuals using culture based (direct culture [DC]) and molecular based techniques (real-time quantitative polymerase chain reaction [qPCR]) in a cross-sectional study model., Materials and Methods: After a full mouth periodontal evaluation, blood samples were taken before and 1 min after professionally-administered interdental brushing. These samples were analyzed by DC and qPCR, targeting Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. Subgingival samples were also collected and analyzed. Student t-test, chi-squar tests and correlations were used for analyzing the data., Results: Thirty individuals per group were included. P. gingivalis and A. actinomycetemcomitans were detected with qPCR methods, but not with DC. At baseline, bacteremia was observed in 5 P patients (16.7%) and in 2 H individuals (6.6%) (p = 0.421). After interdental brushing, bacteremia was only observed in 2 P patients (6.6%) (p = 0.901). A positive correlation between subgingival and blood levels of A. actinomycetemcomitans was observed (r = 0.3; p = 0.013)., Conclusion: Bacteremia related to A. actinomycetemcomitans and P. gingivalis did not significantly increase after a single session of use of interdental brushes., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Aim: To evaluate the prevalence of peri-implant diseases in Spain, as well as the associated risk indicators., Material and Methods: This is a cross-sectional study using a network of sentinel dentists, who randomly selected 10 patients with implants (placed, at least, 5 years before), which were clinically and radiographically evaluated. Case definitions were established for peri-implant mucositis [bleeding on probing (BOP) and no bone level ≥2 mm] and peri-implantitis (BOP plus bone level ≥2 mm). Potential predictor variables, at univariate and multivariate levels, were explored by means of binary logistic regression., Results: A total of 49 sentinel dentists provided complete data from 474 implants in 275 patients. At implant level, prevalences for peri-implant mucositis and peri-implantitis were 27% (95% confidence interval [CI] 22-32) and 20% (95% CI: 15-24), respectively, with 17% of implants (14-21) with bone level ≥2 mm without BOP. At patient level, prevalences were 27% (22-32), 24% (19-29) and 18% (13-22), respectively. In the multiple regression analysis, statistically significant associations for peri-implantitis (p < 0.10) were found for gender, peri-implant supportive therapy, implant location, diameter and surface, type of prosthesis and access to interproximal hygiene., Conclusions: In this representative subject sample across Spain, the prevalence of peri-implant diseases was high (51%)., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: There is no study characterizing the variability of Aggregatibacter actinomycetemcomitans isolates in periodontitis patients in Spain. It is therefore the aim of this investigation to study the serotype distribution of A. actinomycetemcomitans strains isolated from periodontitis patients in Spain. The polymorphism of the genes that codifies the leukotoxin and the operon of the cytolethal-distending toxin (cdt) will also be investigated., Design: From a total of 701 patients samples, 40 A. actinomycetemcomitans-positive periodontitis patients were included in the study (mean age 45.3, 62.5% females) and their clinical periodontal status was assessed. On average, 1-3 isolates from each patient were sub-cultured and characterized by PCR., Results: Using culture the prevalence of A. actinomycetemcomitans was 5.7%. The most frequent serotype was "b", being 30 patients infected by a unique serotype, while 7 patients showed co-colonization, mostly with serotypes "a" and "b". From the 79 pure isolates obtained, 24 were from serotype "a", 30 from serotype "b", 12 from serotype "c" and 4 from serotype "d". Further characterization of these samples showed that none of these 79 isolates demonstrated the 530-bp deletion in the leukotoxin's promoter region that characterizes the JP2 strain. Conversely 65.8% of the isolates were cdt+., Conclusions: The most common serotypes were "a" and "b", being serotype "b" the most prevalent in mono-colonization, while serotypes "e" and "f" were not detected. In the majority of samples, operon that codifies the cdt (65.8%) and the genes responsible for the codification of leukotoxin (100%) were found. None of the isolates were JP2 strains., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Ethnopharmacological Relevance: Sambucus palmensis Link is an endemic species of the Canary Islands, popularly known as "Saúco canario". This species has wide use in folk medicine practice on the islands, especially as analgesic and anti-inflammatory. So the aim of our study is to evaluate the antinociceptive and anti-inflammatory activity of an aqueous extract of this species., Materials and Methods: Three aqueous extract doses (35, 52.5 and 70 mg/kg) were orally administered to laboratory Swiss mice obtained from the Central Animal House of La Laguna University. Writhing responses induced by phenylquinone, formalin induced paw pain response, tail-flick test and paw edema induced by carrageenan were evaluated in this work., Results: Oral pretreatment with 52.5 and 70 mg/kg Sambucus palmensis aqueous extract significantly reduced the writhing number induced by phenylquinone injection (61.64 and 89.04% respectively), and the pain response in the first (36.67 and 38.89%) and second (57.28 and 70.1%) phases respectively of the formalin test. Sambucus palmensis had a very slight effect on tail-flick test and inhibited moderately the edema formation induced by carrageenan in mice., Conclusions: These data show for the first time that Sambucus palmensis has a significant antinociceptive effect that seems to be more peripherical than central. Sambucus palmensis also displays a moderate anti-inflammatory activity in an acute inflammation model. These results support the widespread use of Sambucus palmensis in popular medicine to treat pain and inflammation., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Objective: Area 7 of the autonomous region of Madrid has one of the highest incidences of tuberculosis (23/100,000 population per year 2004). This study aimed to identify tuberculosis control in this area., Methods: A descriptive study of tuberculosis cases diagnosed in area 7 from January 1, 1999 to December 31, 2004 was carried out by analyzing the incidence of tuberculosis and the management of cases and their contacts. We also analyzed the microepidemics that occurred during this period., Results: The incidence of tuberculosis in area 7 during this period was 30.9/100,000 inhabitants. Respiratory tuberculosis accounted for 80.9% of all tuberculosis cases; of these, contact investigation was only undertaken in 38%. Thirty-five percent of cases were lost to follow-up. In the 24 microepidemics detected during the study period, 29 secondary cases were diagnosed; of these, the protocol for contact investigation was not correctly followed in 48%., Conclusion: The lack of information and/or errors in the management of cases and their contacts should be corrected by establishing a new program to ensure proper treatment and follow-up of cases, contact investigations and correct reporting., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objectives: To determine the incidence of acute gastroenteritis in pilgrims on St. James' Way, as well as associated risk factors and microbiological characteristics., Methods: Two studies were designed simultaneously: a cross-sectional study through self-completed questionnaires among pilgrims reaching Santiago, and a case-control study of pilgrims traveling along the Way. Multivariate analysis was performed using logistic regression., Results: In the cross-sectional study, the incidence rate was 23.5 episodes of acute gastroenteritis/10³ pilgrims-day (95% CI: 18.9-2.4/10³. In the case-control study, the major risk factors were age <20 years (OR=4.72; 95% CI: 2.16-10.28), traveling in groups (three or more) (OR=1.49; 95% CI: 0.98-2.28), and drinking unbottled water (OR=2.09; 95% CI: 0.91-4.82). The most frequent etiologic agent was norovirus (56%)., Conclusions: Age less than 20 years, traveling in groups and drinking unbottled water were important risk factors for acute gastroenteritis., (Copyright © 2010 SESPAS. Published by Elsevier Espana. All rights reserved.)

Aim of the Study: Withania aristata is an endemic plant used traditionally in Canary Islands as a diuretic. In this paper, we report on this pharmacological activity in several extracts of the dry vegetal material collected and the identification and diuretic activity of two withanolides, one of them previously not reported, isolated from the most active fraction., Material and Methods: Four Whitania aristata extracts at 100 mg/kg were orally administered to laboratory animals to evaluate their diuretic activity. From the most active fraction, two withanolides were isolated. Both and a mixture of them at 5 and 10 mg/kg were analyzed too as diuretics. Water excretion rate and content of Na(+) and K(+) electrolytes were measured in the urine of saline-loaded animals., Results: Whitania aristata water fraction, the two withanolides and the mixture of these compounds displayed high diuretic activity, with a significant excretion of sodium and potassium ions in laboratory animals., Conclusions: This research supports the ethno-medicinal use of Whitania aristata as diuretic. This activity seems to be associated to the presence of a new type of natural diuretic agents, such as withaferin A and witharistatin.

Ethnopharmacological Relevance: Smilax canariensis is an endemic species of the Canary Islands, popularly known as "Zarzaparrilla sin espinas". This species has wide use in folk-medicine practice on the islands, especially as diuretic. So the aim of our study is to evaluate the diuretic activity of an aqueous and a methanol extract of this species., Material and Methods: Three infusions doses (250, 500 and 750 mg/kg) and two methanol extract doses (100 and 200 mg/kg) were orally administered to laboratory rats. Water excretion rate, pH, density, conductivity, and content of Na(+) and K(+) were measured in the urine of saline-loaded rats., Results: Water excretion rates were significantly increased in a dose-dependent manner by both hot water infusions and the alcohol extract. The electrolytic excretion was also dose-dependent, although potassium excretion was markedly reduced when using the alcohol extract compared with that observed for the infusion., Conclusions: Smilax canariensis presents a notable diuretic effect which appeared to be related both to its potassium content and to the presence of polar organic compounds. The present results provide a quantitative basis explaining the traditional folk-medicine use of Smilax canariensis as a diuretic agent by the Canary Island population.

Aim: To investigate the subgingival microbiota of distinct periodontitis patient populations, in Chile, Colombia and Spain, using identical clinical and bacteriological methods., Material and Methods: In this multicentre study, 114 chronic periodontitis patients were selected. Patients were examined using an identical clinical protocol and pooled subgingival samples were obtained from each patient. Samples were processed in the three laboratories by means of culturing under identical clinical and microbiological protocols. Total anaerobic counts and frequency of detection and proportions of nine periodontal pathogens were calculated. Variables were analysed by means of anova, chi(2), Kruskal-Wallis and Dunn's multiple comparison tests., Results: The Colombian population demonstrated greater severity of periodontitis, with significantly deeper mean probing pocket depth, and had a significantly lower percentage of current smokers. When comparing samples from the three patient populations, the total counts were significantly higher in the Colombian patients. The numbers of putative pathogens differed among groups. Tannerella forsythia was found less frequently in Chilean samples, while Parvimonas micra and enteric rods differed significantly among the three population groups., Conclusion: Significant differences among Chile, Colombia and Spain existed regarding the frequency and proportions of specific periodontal pathogens in the subgingival microbiota of periodontitis patients.

Background: On September 25 2005, more than 100 inmates (almost 5% of the 1,800 prison population) experienced sudden onset gastroenteritis. This outbreak was the largest foodborne outbreak described in a prison population in Spain. Our objective was to confirm the outbreak, identify risk factors, implement control measures, and provide recommendations., Methods: We conducted a cohort analysis of a stratified random sample of all the inmates, a cohort analysis of the one of the prison blocks, and an environmental investigation., Results: A total of 221 inmates were selected, of which 196 were interviewed. Twenty-eight percent had gastroenteritis and the main symptoms were abdominal pain (85%) and diarrhea (71%). All foods consumed caused similar attack rates. Factors associated with the risk of illness were eating the entire portion of seafood cocktail at lunch or all of the fried shrimp at dinner on September 24 (RR = 2; 95% CI, 1.1-3.8, and RR = 1.8; 95% CI, 1.1-3.1). Analysis of one of the prison blocks yielded results similar to those of the random sample. Clostridium perfringens, Bacillus cereus and Escherichia coli were isolated from a sample of the seafood cocktail., Conclusion: A gastroenteritis outbreak caused by several pa-thogens was confirmed. Both the reported symptoms and the calculated incubation periods corresponded to the pathogens isolated. Preparation of food in prison facilities should meet minimum safety standards, including refrigeration and training of food handlers.

This study reports on the pharmacological evaluation of the diuretic activity of an infusion and a methanol extract of Withania aristata Ait. in laboratory rats. Water excretion rate, pH, density, conductivity, and content of Na(+), K(+) and Cl(-) were measured in the urine of rats subjected to hypersaline conditions. Both the infusion and the methanol extract showed a significant diuretic effect compared with non-treated controls, with notable increases in the rates of water and sodium excretion. There was also a potassium retention effect. The diuretic effect did not appear to be related to the potassium content in the material tested, but did have some relation to its content of active polar compounds. The results justify the use of Withania aristata as a diuretic agent in folk medicine of the Canary Islands.

Objectives: To describe non-meningococcal bacterial meningitis (nMM) and to evaluate the Epidemiological Surveillance System (ESS) in the province of Saragossa (Spain) between 1999 and 2004., Methods: Information was obtained from the register of diseases subject to mandatory reporting and the Minimum Basic Data Set (MBDS). The ESS was evaluated by using the Centers for Disease Control and Prevention (CDC) criteria and by estimating the completeness of the system through the capture-recapture technique., Results: 111 cases of nMM were notified (62.2% in males) and the mean age was 40.7 years. The largest proportion of cases (16.5%) occurred in children under 2 years of age. The clinical presentation was meningitis in 81.1%. Diagnosis was through bacterial culture in 70.3%. Streptococcus sp. was found in 54% (82% due to S. pneumoniae), enterobacteria in 5.4%, Listeria and Staphylococcus in 4.5%, Pseudomonas aeruginosa in 1.8%, and Haemophilus influenzae in 0.9%. The incidence rate per 100,000 inhabitants was 1.6 in 2004 and 2.6 in 2001. The case fatality was 7.3%. The completeness of the mandatory reporting system reached a peak in 2004 at 84.4%. The combined completeness of the MBDS and the mandatory reporting system was above 85% and timeliness of reporting was 2 days. The acceptability of the system was high since 75% of all variables were complete in 97% of the questionnaires., Conclusion: We highlight the importance of evaluation of the ESS, based on its results. nMM due to S. pneumoniae represent an important group of diseases and their case fatality is high. The completeness of the ESS in Saragossa was over 80% when the mandatory reporting system and the MBDS were combined. Incorporating the MBDS into surveillance would facilitate the estimation of the real incidence of various diseases subject to mandatory reporting.

Background: We present the results of different studies performed in the investigation of a gastroenteritis outbreak and we describe the difficulties and limitations encountered during its study., Methods: Several analytical studies were designed: one cohort study and one case-control study with different samples sizes., Results: Of the 189 trip participants, 43% answered the questionnaire. Forty-five cases were identified. The factors significantly associated with the disease were: dinner in one of the restaurants of the resort on December 11 in all analytical studies and the excursion to a nearby island in the cohort study., Discussion: The outbreak was confirmed however due to the low response rate and the problems encountered to interview the participants in the trip, it was not possible to identify the route of transmission.

Introduction: Chickenpox is a worldwide disease with high morbidity but few complications, although complications can be sevre in immunocompromised individuals and healthy adults. The annual chickenpox rate declared to the National Notification Disease Surveillance System is approximately 5 cases per 1,000 inhabitants in Extremadura (Spain). The aim of this study was to identify and describe the characteristics and cost of an epidemic outbreak of chickenpox in Extremadura., Methods: Between November 2000 and March 2001, a descriptive study was performed. Cases of chickenpox were actively sought in a cohort of schoolchildren in Herrera del Duque (Badajoz). The protocols of the Monitoring Network of the Autonomous Community of Extremadura was used for case definition. Microbiological confirmation was performed by isolation of the virus and the presence of IgM and IgG markers in serum. We analyzed the direct and indirect tangible costs as well as the intangible costs of the outbreak., Results: Seventy-five cases were identified, of which 94.7% occurred in children aged between 1-9 years, mainly boys. The attack rate was 18.5 cases per 1,000 inhabitants and 68.2% occurred in children aged less than 10 years charing a home. The clinical course was benign, without hospital admissions or complications. A total of 71.6% of children aged between 3 and 8 years were susceptible. A possible temporary aggregation of cases in the school was analyzed and a relative risk of 5.01 (p < 0.0001) was obtained. The virus was isolated in the 4 vesicle samples studied and serology was positive (IgM) in the 9 serum samples studied. The total cost of the outbreak was of 927,21 e, with a mean of 12,53 e per case and 205 school days lost., Conclusion: A chickenpox outbreack was confirmed in Herrera del Duque, with person-to-person transmission, affecting children aged between 1 and 9 years. The high susceptibility of the pupils, the characteristics of teaching, and the meetings prior to the carnivals played a determining role in the transmission of the epidemic. The estimated cost of this outbreak was 76% less than the cost that would have been generated by single-dose vaccination of the 75 individuals who contracted the disease.

Background and Aim of the Study: High morbidity and mortality are attributed to patients with culture-negative endocarditis. The main reason for negative blood culture in infectious endocarditis (IE) is administration of antibiotics before sample withdrawal. The study aim was to determine any difference in prognosis between patients with 'aborted' culture-negative endocarditis (A-CNE) and those with true culture-negative endocarditis (T-CNE)., Methods: A total of 107 patients with a diagnosis of IE was studied retrospectively. Diagnosis was confirmed pathologically during surgery, at post-mortem examination, or by fulfillment of Duke's criteria. Twenty patients (18.7%) had negative-culture endocarditis and comprised the study population. Of these patients, 14 (70%) had received previous antibiotic therapy (A-CNE), and six (30%) were considered T-CNE cases. In-hospital outcome and clinical characteristics were compared between both patient groups. The main end-point was death or need for surgical repair of the heart valves during hospitalization., Results: There were no significant inter-group differences with respect to mean age, gender distribution, and other clinical characteristics. The composite endpoint of death or surgical repair occurred more frequently in T-CNE patients (100% versus 64%, p = 0.0394). Anatomic complications also occurred more frequently in T-CNE patients, but the difference was statistically not significant., Conclusion: Among patients with IE and a negative blood culture, those without previous antibiotic therapy (T-CNE) have the worse prognosis.

Background: The enteritis due to Salmonella is still an important cause of infectious gastroenteritis, that is responsible of 85% of the foodborne outbreaks in Spain. It represents without any doubt a public health problem that involves several health care services and preventive services., Subjects and Method: Using two sources of information: the National Diseases Surveillance System and the Microbiology Laboratories of the Hospitals (MLH) we estimated the incidence of Salmonella infection by the capture-recapture method. Besides, a descriptive study of the disease is done and the more frequent serogroups in the province of Huesca during the period 1996-1999., Results: The total number of cases was 959, which means a media annual rate of 116.6 3 105. The estimated number of cases was 1,145 (media annual rate 5 139.5 3 105). The completeness is higher for the MLH (68%, CI 95%: 66-71). The group D is the more frequent (53.4%) and of this, specially the Salmonella enteritidis. 31% of the cases are under 5 years, and 38.2% are admitted to the hospital. The cases appear seasonally from May to September, with an important peak during the month of August., Conclusions: The improve in the notification and identification of cases by the reporting sources and by the Laboratory Services allowed us to better know the disease. Our results and the proportion of groups-serotypes are similar to the results of other studies.

Objective: To evaluate AIDS case reporting in the Spanish regions as compared with the AIDS deaths registered in mortality statistics, in order to identify possible deviations indicative of underreporting., Methods: We carried out an ecological analysis taking each region as a unit. We compared incidence and mortality obtained from the AIDS reporting system with the HIV/AIDS deaths obtained from the mortality statistics of the Spanish Institute for Statistics. The 1986-1998 period was analysed globally, then the analysis was repeated for the 1995-1998 period., Results: In the 1986-1998 period there was a good correlation (r = 0.93) between the AIDS incidence rates and HIV/AIDS mortality rates obtained from death statistics. Some regions presented an AIDS incidence lower than expected according to their mortality rate when it was compared with the national average, with Asturias (27%), Comunidad Valenciana (26%), Andalucia (20%), Ceuta (18%) and Cantabria (13%) standing out. Taking as a reference the five regions with the highest completeness, the underreporting in Spain was of 13%. In the 1995-1998 period these deviations increased moderately. In the 1986-1998 period, 18.9% less deaths were notified to the AIDS reporting system in comparison with death statistics, showing a great variability between regions., Conclusions: In Spain the reporting level of AIDS cases is acceptable for the aims of surveillance, although in some regions measures to improve it should be taken. The notification of deaths to the AIDS reporting system presents great deficiencies.

Background: The Salmonella and Campylobacter genera are the main bacterial agents causing enteritis in humans in the developed countries. The purpose of this paper is to study the descriptive characteristics of the cases of infection by Salmonella and by Campylobacter and to describe their trend and seasonal variance in the province of Huesca for the 1996-1999 period., Method: The sources of information were the Hospital Microbiological Laboratories (HML's) which conduct coproculture analyses of both outpatients and inpatients. The municipality is taken as the reference unit for plotting the space distribution. For the study of the trend, a multiplicative determinist model is used for grouping the data into four-week periods., Results: A total of 781 cases of infection by Salmonella and 654 cases of infection by Campylobacter have been included, respectively showing mean annual rates of 95 and 79.5 x 10(5) inhabitants. The enteritis by Campylobacter occurs mainly in children under five years of age (73.4%), as compared to the 35.5% of the cases of salmonellosis. The situation is the reverse in the case of the hospital admission percentages, hospitalization due to salmonellosis hence being nearly five times greater. Both of these genera are of a clear-cut seasonal nature, showing a marked peak in the month of August., Conclusions: A growing trend in the number of positive isolations for both of these organisms and a clear seasonality in the summertime have been found.

In 1994, the Instituto de Salud Carlos III (ISCIII; Carlos III Health Institute) of the Spanish Ministry of Health and the Consumer (MSC) created the Programa de Epidemiología Aplicada de Campo (PEAC; Applied Field Epidemiology Programme). The programme is managed by the Centro Nacional de Epidemiología (National Epidemiological Centre) in collaboration with the Escuela Nacional de Sanidad (National School of Health), and supported by General Direction for Health and Consumer of MSC and the Health Councils (Consejerías de Sanidad) of the autonomous regions. The PEAC runs a masters degree programme in applied field epidemiology, in which degrees are conferred by the National School of Health. As PEAC is a national programme, it forms a part of the European Program for Intervention Epidemiology Training (EPIET) and is a member of the Network Training for Epidemiology Public Health Intervention (TEPHINET), the association of 27 regional and national programmes of the acting Intervention Epidemiology Training Programs.

The purpose of this study was to compare the subgingival microbiota of two geographically distinct patient populations using identical clinical and bacteriological methods. Adult patients with a diagnosis of periodontitis were consecutively selected according to pre-defined clinical criteria. Microbiological samples were taken from the deepest four sites with bleeding. The samples were plated on blood agar plates, for the determination of the total anaerobic counts and identification of specific bacterial pathogens, and on TSBV and McConkey for isolation of Actinobacillus actinomycetemcomitans and enteric rods, respectively. Thirty-one patients in Spain and 30 patients in The Netherlands were selected. Both patient groups showed similar clinical characteristics, both in terms of age, gender and periodontal clinical variables. A. actinomycetemcomitans was significantly more prevalent (23.3% vs. 3.2%) in the Dutch group, while Porphyromonas gingivalis was significantly more prevalent (64.5% vs. 36.7%) in the Spanish group. Bacteroides forsythus and most commensal periodontal pathogens showed similar prevalences, except Peptostreptococcus micros that was significantly more frequent in the Dutch group (96.7% vs. 74.2%). In summary, the subgingival microbiota from the Spanish group was characterised by a high prevalence of P. gingivalis and low of A. actinomycetemcomitans, while the flora from the Dutch group was characterised by a high prevalence of A. actinomycetemcomitans and P. micros.

Background/aims: Countries with a high per capita antibiotic use frequently demonstrate a high level of drug resistance. The aim of this study was to compare the prevalence and levels of beta-lactamase producing bacteria in the subgingival microflora in adult patients with periodontitis in Spain and The Netherlands, and to characterise beta-lactamase producing bacteria in both patient samples., Method: Patients with moderate to severe periodontitis were consecutively selected and asked to report on: current systemic disorders and medications, history of use of antibiotics, and smoking habits. Clinical variables included probing pocket depth, clinical attachment level, plaque, bleeding on probing, and suppuration. Pooled subgingival samples of 4 selected sites were anaerobically cultured in blood agar plates with and without amoxicillin, and amoxicillin/clavulanate. Bacterial colonies growing on amoxicillin plates but not on amoxicillin/clavulanate plates were tested for beta-lactamase production. beta-lactamase producing bacteria were isolated and identified., Results: 31 patients were studied in the Spanish group and 30 in the Dutch group. Comparable mean gender and ages were found. Evaluation of previous antibiotic use revealed that, in the previous 12 months, 54.8% of patients in the Spanish group and 10% in the Dutch group reported antibiotic use (p<0.001). The prevalence of beta-lactamase producing bacteria was 87.1% in the Spanish group and 73.3% in the Dutch group. Total counts of beta-lactamase producing bacteria on amoxicillin plates (p<0.01), the mean number of different beta-lactamase producing colonies per patient (p<0.001), and the number of amoxicillin resistant colonies (p<0.001) were significantly higher in the Spanish group. 74 beta-lactamase producing strains in the Spanish group and 33 in the Dutch group were isolated for identification. 23 out of 35 identified strains in the Spanish group, and 32 out of 33 in the Dutch group belonged to Prevotella genus., Conclusions: A high prevalence of beta-lactamase producing bacteria has been evaluated in two distinct populations, belonging to two European countries with clear differences in antibiotic usage policy. A higher prevalence and a more complex beta-lactamase producing microflora, were found in the Spanish group, associated with a higher antibiotic consumption. This study shows that a higher use of beta-lactam antibiotics is reflected in the % of beta-lactamase producing bacteria in the subgingival microflora of patients with periodontitis. This information may be important in the treatment of severe periodontitis.

The widespread use of antibiotics for treatment of bacterial infections has lead to the emergence of resistant human pathogens. Great differences have been documented between European countries in the use of systemic antibiotics. In parallel, significant differences in levels of resistant pathogens have been documented. In order to investigate whether differences in antibiotic use influence the level of antimicrobial resistance of the subgingival microflora, microorganisms from the subgingival plaque of untreated patients with adult periodontitis in The Netherlands (n = 30) and Spain (n = 31) were compared. Blood agar plates containing breakpoint concentrations of penicillin, amoxicillin, amoxicillin and clavulanate, metronidazole, erythromycin, azithromycin, clindamycin and tetracycline were used to determine the proportion of bacteria from the subgingival plaque that was resistant to these antibiotics. In the Spanish patients, statistically significant higher mean levels of resistance were found for penicillin, amoxicillin, metronidazole, clindamycin and tetracycline. The mean number of different bacterial species growing on the selective plates was higher in the Spanish patients, as was the percentage of resistant strains of most periodontal pathogens. A striking difference was observed in the frequency of occurrence of tetracycline-resistant periodontal pathogens. In Spain, 5 patients had > 3 tetracycline resistant periodontal pathogens, whereas this was not observed in any of the Dutch patients. It is concluded that the widespread use of antibiotics in Spain is reflected in the level of resistance of the subgingival microflora of adult patients with periodontitis.

Spain's Salmonella surveillance system backed by regionally-based epidemiologists around the country made it possible to detect and halt the spread of a foodborne salmonellosis outbreak due to powdered infant formula contaminated with a lactose-fermenting strain of Salmonella virchow. Forty-eight cases involving children, mostly under 7 months old, were detected in 14 out of Spain's 17 Regions. The outbreak started in January and ended in June 1994. All cases were microbiologically confirmed. The implicated strain had a 3.6 kb plasmid, was susceptible to all antimicrobials tested except nitrofurantoin and was phagetype 4a. Isolates from 8 of 24 Brand "A" milk samples tested had the same characteristics as case isolates. All affected/suspect batches of Brand "A" milk were destroyed and the product withdrawn from sale, which led to the end of the outbreak. This incident underscores the importance of maintaining surveillance systems able to detect and prevent foodborne outbreaks and alert to the possibility of isolating unusual lactose-fermenting Salmonella serotypes in especially sensitive food products.