Search

OBJECTIVE: Several health care organizations recommend that physicians provide preventive dentistry services, including dental screening and referral. This study is the first to investigate characteristics of medical providers that influence their referral to a dentist of children who are at risk for dental disease. METHODS: A cross-sectional survey was undertaken of primary care clinicians in 69 pediatric practices and 49 family medicine practices who were enrolled in a study to evaluate a pediatric preventive dentistry program targeted toward Medicaid-eligible children in North Carolina. A 100-item, self-administered questionnaire with 23 items on some aspect of dental referral elicited providers' knowledge and opinions toward oral health, their provision of dental services, and their confidence in providing these services. We hypothesized that providers' dental knowledge, opinions about the importance of oral health, and confidence in providing oral health services would be associated with their propensity to refer children who are younger than 3 years and are suspected of having risk factors for future dental disease or a few teeth in the beginning stages of decay. We also hypothesized that providers' perceived referral difficulty would affect their referral activities. Patient characteristics (tooth decay status, insurance status, immigrant status, English speaking), practice characteristics (setting, number of providers, patient volume, busyness), practice environment (perceived and actual availability of dentists), and other provider characteristics (gender, type, practice experience, board certification, training in oral health during or after professional education, hours worked, teaching of residents, preventive behaviors) were assessed and used as control variables. Preliminary bivariate analysis (analysis of variance, chi2) identified characteristics associated with referral activity. Multivariable logistic regression analysis using backward stepwise logistic regression tested the posed hypotheses, with provider, practice, and patient characteristics included as potential control variables. RESULTS: Nearly 78% of 169 primary care clinicians who participated in the survey reported that they were likely to refer children who had signs of early decay or high risk for future disease. Approximately half (54%) call a dental office sometimes or more frequently to make an appointment for a child whom they refer, but the most common method is to give the caregiver the name of a dentist without additional assistance (96%). Bivariate analysis revealed that providers who had high confidence in their ability to perform screenings and reported low overall referral difficulty were more likely to refer children. Bivariate analyses also found that providers who were not in group practices, were board certified, graduated 20 years ago or more, saw 80 or more patients per week, had >60% of their total patients who were infants and toddlers, and saw >3.5 patients per hour were significantly less likely to refer at-risk children for dental care. No patient characteristics were associated with referral. The regression model revealed that an increase in odds of referral was significantly associated with confidence in screening abilities (odds ratio [OR]: 5.0; 95% confidence interval [CI]: 1.7-15.1), low referral difficulty (OR: 6.0; 95% CI: 1.0-34.5), and group practice (OR: 4.2; 95% CI: 1.4-12.1). Having a patient population of >60% infants or toddlers was significantly associated with a decrease in odds of referral (OR: 0.2; 95% CI: 0.1-0.7). Oral health knowledge and opinions did not help to explain referral practices. CONCLUSIONS: Tooth decay remains a substantial problem in young children and is made worse by existing barriers that prevent them from obtaining dental care. Because most children are exposed to medical care but not dental care at an early age, primary care medical providers have the opportunity to play an important role in helping children and their families gain access to dental care. This study has identified several factors that need consideration in the further exploration and development of primary care physicians' role in providing for the oral health of their young patients. First, instructional efforts to increase providers' dental knowledge or opinions of the importance of oral diseases are unlikely to be effective in increasing dental referral unless they include methods to increase confidence in providers' ability to identify and appropriately refer children with disease. Medical education in oral health may need to be designed to include components that address self-efficacy in providing risk assessment, early detection, and referral services. Traditional, didactic instruction does not fulfill these requirements, but because the effectiveness of instructional methods for teaching medical providers oral health care, particularly confidence-building aspects, is untested, controlled evaluations are necessary. A second conclusion from this study is that the referral environment is more important than provider knowledge, experience, opinions, or patient characteristics in determining whether medical practitioners refer at-risk children for dental care. Most providers in this study held positive opinions about providing dental services in their practices, had relatively high levels of knowledge, screened for dental disease, accessed risk factors in their patients, and referred; they can be instrumental in helping young children get dental care, yet most providers face difficulties in making dental referrals, and changes in the availability of dental care will be necessary to decrease these barriers before referral can be most effective. The longer-term approach of increasing the number of dental graduates can be complemented in the shorter term by other approaches to increase dentists' participation in Medicaid, such as increases in reimbursement rates; training general dentists to treat young children; and community organization activities to link families, physicians, dentists, and public programs such as Early Head Start. Finally, pediatric primary health care providers can provide oral health promotion and disease prevention activities, thereby eliminating or delaying dental disease and the need for treatment at a very young age. However, effective and appropriate involvement of pediatric primary care clinicians can be expected only after they receive the appropriate training and encouragement and problems with the dental referral environment are addressed. [ABSTRACT FROM AUTHOR]

Popular medicine has been using oleoresin from several species of copaíba tree for the treatment of various diseases and its clinical administration potentially causes antinociception. Electrical stimulation of ventrolateral (vlPAG) and dorsolateral (dlPAG) columns of the periaqueductal gray matter also causes antinociception. The aim this study was to verify the antinociceptive effect of oleoresin extracted from Copaifera langsdorffii tree and to test the hypothesis that oleoresin-induced antinociception is mediated by µ 1 - and κ-opioid receptors in the vlPAG and dlPAG. Nociceptive thresholds were determined by the tail-flick test in Wistar rats. The copaíba tree oleoresin was administered at different doses (50, 100 and 200 mg/kg) through the gavage technique. After the specification of the most effective dose of copaíba tree oleoresin (200 mg/kg), rats were pretreated with either the µ 1 -opioid receptor selective antagonist naloxonazine (at 0.05, 0.5 and 5 µg/ 0.2 µl in vlPAG, and 5 µg/ 0.2 µl in dlPAG) or the κ-opioid receptor selective antagonist nor-binaltorphimine (at 1, 3 and 9 nmol/ 0.2 µl in vlPAG, and 9 nmol/ 0.2 µl in dlPAG). The blockade of µ 1 and κ opioid receptors of vlPAG decreased the antinociception produced by copaíba tree oleoresin. However, the blockade of these receptors in dlPAG did not alter copaíba tree oleoresin-induced antinociception. These data suggest that vlPAG µ 1 and κ opioid receptors are critically recruited in the antinociceptive effect produced by oleoresin extracted from Copaifera langsdorffii., Competing Interests: Declaration of Competing Interest The authors declare that there are no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier B.V. All rights reserved.)

We present here Mycobacteriophage NoShow, isolated from a soil sample collected on the Maguire Campus of Saint Joseph's University in Merion Station, Pennsylvania. Even though NoShow's 52,825 bp genome is most similar to phages in cluster AB, its lysA and lysB genes are most similar to phages in cluster H2., Competing Interests: The authors declare no conflict of interest.

Objetivo: Proporcionar recomendaciones para la detección temprana de pacientes con alto riesgo de desarrollar cáncer de pulmón (CP) en el primer nivel de atención y su referencia oportuna. Material y métodos. Se realizó una búsqueda detallada de la evidencia científica disponible para responder las preguntas de investigación clínica y se utilizó el Panel Delphi modificado para lograr un consenso entre expertos., Resultados: Se generaron 14 recomendaciones siguiendo los estándares de una GPC. Conclusión. El CP representa un problema de salud pública en México; por ello, esta guía establece recomendaciones que apoyan la toma de decisiones sobre la detección precoz y la referencia de pacientes con sospecha de CP en el primer nivel de atención.

In this work, we present a theoretical study of the dispersion of linearly polarized light between two dielectric media separated by an anisotropic two-dimensional (2D) material under oblique incidence. Assuming that the 2D material is a conducting sheet of negligible thickness, generalized Fresnel coefficients are derived as a function of usual quantities (e.g. refraction indexes and scattering angles) and the anisotropic in-plane optical conductivity of the interstitial 2D material. In particular, we analyzed the modifications due to the 2D material of two classical optical phenomena: the Brewster effect and the total internal reflection. As a application, our general findings are particularized for uniaxially strained graphene. Effects of a uniaxial strain on the Brewster angle and the reflectance (under total internal reflection) are evaluated as a function of the magnitude and direction of strain.

Mutation of a single residue within the recently identified lipid (diacylglycerol) recognition window of TRPC3 (G652A) was found to abolish channel activation via endogenous lipid mediators while retaining sensitivity to the non-lipid activator GSK1702934A (abb. GSK). The mechanism of this change in chemical sensing by TRPC3 was analysed by whole-cell and single channel electrophysiology as well as Ca 2+ imaging. Currents initiated by GSK or the structural (benzimidazole) analog BI-2 were significantly larger in cells expressing the G652A mutant as compared to wild type (WT) channels. Whole cell patch-clamp experiments revealed that enhanced sensitivity to benzimidazoles was not due to augmented potency but reflected enhanced efficacy of benzimidazoles. Single channel analysis demonstrated that neither unitary conductance nor I-V characteristics were altered by the G652A mutation, precluding altered pore architecture as the basis of enhanced efficacy. These experiments uncovered a distinct gating pattern of BI-2-activated G652A mutant channels, featuring a unique, long-lived open state. Moreover, G652A mutant channels lacked PLC/diacylglycerol mediated cross-desensitization for GSK activation as typically observed for TRPC3. Lack of desensitization in G652A channels enabled large GSK/BI-2-induced Ca 2+ signals in conditions that fully desensitized TRPC3 WT channels. We demonstrate that the lipid-recognition window of TRPC3 determines both sensitivity to lipid mediators and chemical gating by benzimidazoles. TRPC3 mutations within this lipid interaction site are suggested as a basis for chemogenetic targeting of TRPC3-signaling., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The use of placebo has spread in clinical practice despite being controversial. In Mexico, the practice of family medicine is predominantly institutional and works with an essential medications list., Objective: To determine the frequency and family doctor attitude regarding the use of placebos in clinical practice., Method: Cross-sectional, observational, multicenter study of 307 family doctors with active practice in 27 states of the Mexican Republic. A questionnaire was used with sociodemographic data and consensus-developed questions about frequency of use and attitudes. For analysis, the square-chi test was used., Results: 75% used placebos (95% CI=69.7-79.4%); 122 (39.7%) used pure placebos, mainly water (p < 0.05), and 220 (71.6%), impure placebos, mainly vitamins and laboratory tests. They were used more in patients with medically unexplained physical symptoms (178, 45.5%), including 122 (31.2%) "healthy worried" patients, or who had chronic conditions (40, 12.5%). Reasons for prescription: 249 (81%) for the psychological effect, when they showed benefit (176, 57%), even when it implied deceiving (78, 25%) or insufficient evidence of efficacy (57, 19%). The main reason was because of patient insistence., Conclusions: More impure placebos were used, mainly in healthy worried patients and in those with chronic conditions., (Copyright: © 2019 Permanyer.)

Transient receptor potential canonical (TRPC) channels TRPC3, TRPC6 and TRPC7 are able to sense the lipid messenger diacylglycerol (DAG). The DAG-sensing and lipid-gating processes in these ion channels are still unknown. To gain insights into the lipid-sensing principle, we generated a DAG photoswitch, OptoDArG, that enabled efficient control of TRPC3 by light. A structure-guided mutagenesis screen of the TRPC3 pore domain unveiled a single glycine residue behind the selectivity filter (G652) that is exposed to lipid through a subunit-joining fenestration. Exchange of G652 with larger residues altered the ability of TRPC3 to discriminate between different DAG molecules. Light-controlled activation-deactivation cycling of TRPC3 channels by an OptoDArG-mediated optical 'lipid clamp' identified pore domain fenestrations as pivotal elements of the channel´s lipid-sensing machinery. We provide evidence for a novel concept of lipid sensing by TRPC channels based on a lateral fenestration in the pore domain that accommodates lipid mediators to control gating.

Upon controlled microwave heating and using cyanuric chloride as a coupling reagent, an efficient amidation procedure for the synthesis of 1,3-dihydro-2 H -benzo[ d ]imidazol-2-one-based agonists of TRPC3/6 ion channels has been developed. Compared to the few conventional protocols, a drastic reduction in processing time from ca. 2 days down to 10 minutes was achieved accompanied by significantly improved product yields. The robustness of the method was confirmed by 18 additional examples including aromatic, aliphatic, and heterocyclic amines and acids. The obtained agonists were screened for biological activity at 1 μM concentration and few structure-activity relations have been established.

Objective: The aim of this paper is to evaluate the effect of the DiabetIMSS program on cardiovascular risk, blood pressure and HDL cholesterol in patients with metabolic syndrome., Methods: Quasi-experimental intervention study. Non-probabilistic convenience sampling. 35 subjects in the educational strategy one year were included. The following variables were collected: age, gender, smoking, total cholesterol, HDL cholesterol, systolic and diastolic blood pressure; cardiovascular risk calculator based on Framingham is calculated. Descriptive and inferential statistical percentages with Student t test was used., Results: There was an increase in the proportion of subjects increased their subsequent figures HDL cholesterol intervention, there by generating an increase of protective factor (p < 0.05). Because of the blood pressure a marked improvement in all ranges of blood pressure (p < 0.05) was presented., Conclusions: The educational strategy for the control of diabetic patients presented a favorable performance in HDL-cholesterol and blood pressure, reducing the risk of cardiovascular patients.

Photouncaging of second messengers has been successfully employed to gain mechanistic insight of cellular signaling pathways. One of the most enigmatic processes of ion channel regulation is lipid recognition and lipid-gating of TRPC channels, which represents pivotal mechanisms of cellular Ca(2+) homeostasis. Recently, optopharmacological tools including caged lipid mediators became available, enabling an unprecedented level of temporal and spatial control of the activating lipid species within a cellular environment. Here we tested a commonly used caged ligand approach for suitability to investigate TRPC signaling at the level of membrane conductance and cellular Ca(2+) handling. We report a specific photouncaging artifact that is triggered by the cage structure coumarin at UV illumination. Electrophysiological characterization identified a light-dependent membrane effect of coumarin. UV light (340 nm) as used for photouncaging, initiated a membrane conductance specifically in the presence of coumarin as low as 30 μmol L(-1) concentrations. This conductance masked the TRPC3 conductance evoked by photouncaging, while TRPC-mediated cellular Ca(2+) responses were largely preserved. The observed light-induced membrane effects of the released caging moiety may well interfere with certain cellular functions, and prompt caution in using coumarin-caged second messengers in cellular studies.

Background: Morbid obesity is directly related to deterioration in cardiorespiratory capacity, including changes in cardiovascular autonomic modulation., Objective: This study aimed to assess the cardiovascular autonomic function in morbidly obese individuals., Methods: Cross-sectional study, including two groups of participants: Group I, composed by 50 morbidly obese subjects, and Group II, composed by 30 nonobese subjects. The autonomic function was assessed by heart rate variability in the time domain (standard deviation of all normal RR intervals [SDNN]; standard deviation of the normal R-R intervals [SDNN]; square root of the mean squared differences of successive R-R intervals [RMSSD]; and the percentage of interval differences of successive R-R intervals greater than 50 milliseconds [pNN50] than the adjacent interval), and in the frequency domain (high frequency [HF]; low frequency [LF]: integration of power spectral density function in high frequency and low frequency ranges respectively). Between-group comparisons were performed by the Student's t-test, with a level of significance of 5%., Results: Obese subjects had lower values of SDNN (40.0 ± 18.0 ms vs. 70.0 ± 27.8 ms; p = 0.0004), RMSSD (23.7 ± 13.0 ms vs. 40.3 ± 22.4 ms; p = 0.0030), pNN50 (14.8 ± 10.4 % vs. 25.9 ± 7.2%; p = 0.0061) and HF (30.0 ± 17.5 Hz vs. 51.7 ± 25.5 Hz; p = 0.0023) than controls. Mean LF/HF ratio was higher in Group I (5.0 ± 2.8 vs. 1.0 ± 0.9; p = 0.0189), indicating changes in the sympathovagal balance. No statistical difference in LF was observed between Group I and Group II (50.1 ± 30.2 Hz vs. 40.9 ± 23.9 Hz; p = 0.9013)., Conclusion: morbidly obese individuals have increased sympathetic activity and reduced parasympathetic activity, featuring cardiovascular autonomic dysfunction.

Background: The safe use in biomedicine of semiconductor nanoparticles, also known as quantum dots (QDs), requires a detailed understanding of the biocompatibility and toxicity of QDs in human beings. The biological characteristics and physicochemical properties of QDs entail new challenges regarding the management of potential adverse health effects following exposure. At certain concentrations, the synthesis of semiconductor nanoparticles of CdS using dextrin as capping agent, at certain concentration, to reduce their toxicity and improves their biocompatibility., Results: This study successfully synthesized and characterized biocompatible dextrin-coated cadmium sulfide nanoparticles (CdS-Dx/QDs). The results show that CdS-Dx/QDs are cytotoxic at high concentrations (>2 μg/mL) in HepG2 and HEK293 cells. At low concentrations (<1 μg/mL), CdS-Dx/QDs were not toxic to HepG2 or HeLa cells. CdS-Dx nanoparticles only induced cell death by apoptosis in HEK293 cells at 1 μg/mL concentrations. The in vitro results showed that the cells efficiently took up the CdS-Dx/QDs and this resulted in strong fluorescence. The subcellular localization of CdS-Dx/QDs were usually small and apparently unique in the cytoplasm in HeLa cells but, in the case of HEK293 cells it were more abundant and found in cytoplasm and the nucleus. Animals treated with 100 μg/kg of CdS-Dx/QDs and sacrificed at 3, 7 and 18 h showed a differential distribution in their organs. Intense fluorescence was detected in lung and kidney, with moderate fluorescence detected in liver, spleen and brain. The biocompatibility and toxicity of CdS-Dx/QDs in animals treated daily with 100 μg/kg for 1 week showed the highest level of fluorescence in kidney, liver and brain. Less fluorescence was detected in lung and spleen. There was also evident presence of fluorescence in testis. The histopathological and biochemical analyses showed that CdS-Dx/QDs were non-toxic for rodents., Conclusions: The in vitro and in vivo studies confirmed the effective cellular uptake and even distribution pattern of CdS-Dx/QDs in tissues. CdS-Dx/QDs were biocompatible with tissues from rodents. The CdS-Dx/QDs used in this study can be potentially used in bio-imaging applications.

Beginning in January 2000, all individuals participating in basic military training at Fort Leonard Wood, Missouri, were issued boil-and-bite mouthguards. From January 2000 to March 2001, trainees were required to wear mouthguards only for a single activity, pugil stick training. After March 2001, mouthguards were required for four activities including pugil stick training, unarmed combat, rifle/bayonet training, and the confidence/obstacle course. Dentists systematically tracked trainees who reported to the dental clinic with orofacial injuries during three periods: January 2000-March 2001 (phase 1), April-September 2001 (phase 2) and September 2002-June 2003 (phase 3). Orofacial injury rates were 3.35, 1.89 and 1.91 cases/10,000 person-years in phases 1, 2 and 3, respectively. The overall risk of an orofacial injury was 1.76 (95% confidence interval = 1.03-3.02) times higher in phase 1 compared with the combined phases 2 and 3 (P = 0.006). Thus, orofacial injury rates were lower when mouthguards were required for four training activities as opposed to one training activity. Mouthguards are now required at all five Army basic training sites when trainees are performing any of the four training activities.

A biomarker for lifetime fluoride exposure would facilitate population-based research and policy making but currently does not exist. This study examined the suitability of primary tooth dentin as a biomarker by comparing dentin fluoride concentration and fluoride exposures. Ninety-nine children's exfoliated primary teeth were collected from 2 fluoridated and 2 fluoride-deficient communities in North Carolina. Coronal dentin was isolated by microdissection and fluoride concentration assayed using the microdiffusion, ion-specific electrode technique. Information on children's fluoride exposures since birth from drinking water, toothpaste, supplements, rinses, food and beverages was collected by a self-reported questionnaire administered to caregivers. Only a small portion of the variance (10%) in incisor dentin fluoride (mean 792, SD 402 mg/kg) was accounted for by the best linear regression model as evaluated by the adjusted R(2). A moderate portion of the variance (60%) of molar dentin fluoride (mean 768, SD 489 mg/kg) was predicted by dietary fluoride supplement exposures, community of residence, and frequent tea consumption. Results for molars suggest that primary tooth dentin concentration may prove to be a satisfactory biomarker for fluoride exposure., ((c) 2008 S. Karger AG, Basel.)

A young woman with achondroplasia and morbid obesity (two disabling conditions) is presented. She underwent open Roux-en-Y gastric bypass (RYGBP). We emphasize preoperative preparation by a multidisciplinary team and the use of the 6-minute walk test to follow and assess mobility and quality of life.

Infectious disease is the most significant cause of morbidity and mortality in allotransplantation because of heavy immunosuppression. Brain abscesses caused by melanized fungi have been found occasionally and are an example of this complication. In this paper, we describe a case in a 61-year-old black man, who received a cadaveric kidney transplantation in December 1993, followed by triple therapy with cyclosporine, azathioprine, and prednisone. The patient developed right hemiparesis at the beginning of April 1998. A computed tomography scan showed a mass in the left parieto-temporal region of the brain. The patient underwent surgery and a brown-colored encapsulated brain abscess was resected. Histology of the tissue revealed a large number of pigmented fungal hyphae. Culture in a Sabouraud dextrose medium with cyclohexamide and chloramphenicol at 25 degrees C resulted in the growth of dark-green colonies. The fungus identified was Cladophialophora bantiana, based on characteristic microscopic features and on growth at 40 degrees C. The abscess recurred in spite of treatment with fluconazole. The patient was submitted to a second brain surgical procedure and was treated with amphotericin B in addition to fluconazole. Ten days later the patient's blood cultures became positive for Escherichia coli. After 3 days the patient died due to septic shock.

A 36-old-woman was admitted with an infectious syndrome, respiratory insufficiency and vasculitis. There was a history of chronic intravenous drug abuse, sexual promiscuity and rheumatic heart disease. She had HIV positive tests. The vasculitis and heart failure worsened and the patient died of stroke. At autopsy it was found histologic evidence of AIDS, rheumatic heart disease with Aschoff nodes, infective endocarditis with cerebral abscesses and thalamic infarction.