Accuracy of direct examination and culture as compared to the anatomopathological examination for the diagnosis of chromoblastomycosis: a systematic review

BackgroundChromoblastomycosis is a skin infection caused by dematiaceous fungi that take the form of muriform cells in the tissue. It mainly manifests as verrucous plaques on the lower limbs of rural workers in tropical countries.ObjectivesThe primary objective of this review is to evaluate the accuracy of diagnostic methods for the identification of chromoblastomycosis, considering the histopathological examination as the reference test.MethodsMEDLINE, LILACS and Scielo databases were consulted using the terms “chromoblastomycosis” AND “diagnosis”. The eligibility criteria were: studies that evaluated the accuracy of tests for the diagnosis of chromoblastomycosis. Eleven studies were selected. Statistical analysis included the calculation of sensitivity and specificity of the diagnostic methods.ResultsConsidering the histopathological examination as the reference test, the culture showed a sensitivity (S) of 37.5% - 90.9% and a specificity (Sp) of 100%; while direct mycological examination showed S = 50% - 91.6% and Sp of 100% . Considering the culture as the reference test, the serology (precipitation techniques) showed S of 36% - 99%; and Sp of 80% - 100%; while the intradermal test showed S of 83.3% - 100% and Sp of 99.4% - 100%.Study limitationsThe small number of studies and very discrepant sensitivity results among them do not allow the calculation of summary measures through a meta-analysis.ConclusionsDirect mycological examination, culture, intradermal test and serology show sensitivity and specificity values ??for the diagnosis of chromoblastomycosis with no significant difference between the studies.     

Usefulness of the Aesthetic Result as a Success Criterion for Implant Therapy: A Review

Purpose: The purpose of this study was to review the reported evaluation criteria of the aesthetic result in oral implant rehabilitation. Materials and Methods: A literature search of MEDLINE, the Cochrane Collaboration, and EMBASE was performed to retrieve studies published between January 1990 and December 2008 using the following key words: “dental implants,”“clinical trial,” and “aesthetic index” (and their synonyms). A manual search of the literature published in the same period was also carried out using the following publications: Clinical Oral Implant Research, The International Journal of Oral and Maxillofacial Implants, and The International Journal of Periodontics and Restorative Dentistry. The inclusion criteria of the published studies were the following: human clinical trial, oral implant rehabilitation, at least 10 implants, at least 6 months of follow‐up from insertion of the prosthesis, and evaluation of the aesthetic result by means of an index. Results: The literature search revealed 650 relevant bibliographic references, of which 89 were selected for further analysis. A final total of 29 articles fulfilled the inclusion criteria; these included 10 retrospective case series, 11 prospective case series, 1 retrospective controlled clinical trial, 1 prospective controlled clinical trial, and 6 randomized controlled clinical trials. In general, evaluations of aesthetic results appear only in the more recent studies and refer mostly to implant rehabilitation in the maxillary anterior zone; the index used, in most cases, was the Papilla Index of Jemt. Conclusions: Although there appears to be a growing interest in aesthetics in dental implantology, there are as yet no universally accepted evaluation criteria of the aesthetic result. Therefore, further research is necessary to establish a common, complete, and reproducible index for the evaluation of aesthetic outcome that can add in the success criteria for implant therapy in the maxillary and mandibular anterior areas.     

Drugs and psychoactive substances in the Tiber River

Wastewater analysis is a direct and objective method used to measure human consumption of illicit drugs. In the last few years these have become a new class of environmental contaminants. The aim of our study was the identification of drugs in Tiber River waters. We collected 20 water samples from May to June 2012, at six points of the river: at the source, near Perugia, near Rome and at the mouth. Samples were analysed using gas chromatography with a mass detector. Basic analytes were extracted using the method of Varian Certify. For acidic analytes we proceed to direct extraction using organic solvents. The most detected drug was ecstasy. We also identified traces of methadone, morphine, heroine, methylamphetamine and tetrahydrocannabinol (THC). The highest concentration of cocaine was found near Perugia with a peak in the weekend (4744 ng/ml). Psychoactive substances had constant concentrations in the week. Ecstasy (MDMA) was the most detected drug. The most interesting finding was the increased concentration of cocaine and heroin in waters near Perugia showing the alarming phenomenon of weekend use of these substances.     

Over-expression of IGF-related peptides in stenoses of native arteriovenous fistulas in hemodialysis patients.

INTRODUCTION: Insulin-like growth factors (IGFs) are known to play an important role in atherogenesis. The aim of our study was to assess the local expression of IGF-related peptides in stenosed hemodialysis fistulas and compare these with their respective serum levels. METHODS: We investigated 15 stenosed vein segments of primary arteriovenous fistulas, 29 non-stenosed control vein segments from uremic patients and 15 non-stenosed control saphenous vein segments. Immunohistochemistry was performed for IGF-I, insulin, IGF-binding proteins (IGFBPs)-1, -2, -3 and -4, the acid labile subunit (ALS) and type 1 IGF-receptor (IGF-R). Serum levels were measured by specific radioimmunoassays. RESULTS: Compared to both control groups, a significantly higher expression of the following IGF-related peptides was seen in the stenotic (neo)intima: IGF-I, IGFBP-1, -2, -3, -4 and IGF-R; in the stenotic media: IGF-I and IGFBP-3 and in the endothelium of stenotic fistulas: IGF-I (all p<0.05). Staining against ALS and insulin was negative in all vessels. Serum IGF-I levels did not differ. Serum levels of IGFBP-1, -2, -3 and -4 were significantly higher in patients with renal disease (all p<0.05). There were no correlations between local and systemic IGF-related peptide levels. There were correlations of neointimal expression of IGF-I, IGFBP-1, -2, -3, -4 and IGF-R with both hypercellularity and the presence of inflammatory cells (p<0.05). CONCLUSION: In the stenotic arteriovenous fistula of hemodialysis patients, expression of the peptides IGF-I, IGFBP-1, -2, -3, -4 and IGF-R was significantly increased and showed a positive correlation with neointimal inflammation and hypercellularity (all p<0.05). IGF-related peptides are most likely synthesized locally and might be involved in the initiation and/or progression of neointimal thickening of primary arteriovenous fistulas.