Microbiologic Findings in Relation to Risk Assessment for Periodontal Disease: A Cross‐Sectional Study

Background: In this study, an association between a computerized risk calculator and microbiologic testing is examined in patients with periodontitis. Methods: Seventy‐four patients with moderate and severe periodontitis were selected from patients receiving treatment at Tufts University School of Dental Medicine. Their periodontal risk was analyzed with a periodontitis risk assessment tool, and microbiologic testing was performed. Periodontitis risk assessment and microbiologic testing were examined for a possible association. The data were evaluated by the χ² test at P <0.05 levels. Results: Forty‐six patients scored as having a “very high” risk of periodontitis and 22 patients scored as having a “high” risk of periodontitis by the risk assessment tool. Patients with a risk score of very high risk showed a higher detection of each bacterium except Capnocytophaga species than the rest of the study population. Treponema denticola and Prevotella intermedia (P = 0.01 and P = 0.02, respectively) were two bacteria that showed a statistically significant difference between patients at very high risk and those at high risk. Conclusions: Patients with periodontitis were identified as high risk and very high risk compared with the rest of the risk categories by the risk assessment tool. The study population, categorized mostly as very high risk, showed high detection of putative periodontal bacteria.     

T lymphocyte abnormalities in disseminated histoplasmosis

Disseminated histoplasmosis is associated with depression of T cell-mediated immunity and in some cases anergy. In this report, two patients with disseminated disease are described. Both had a depression of T cell-mediated immunity as well as other abnormalities of immune response. In one, a patient with relapse, a marked depression in the ratio of T helper to T suppressor cells was noted. Neither patient had any predisposing condition known to be associated with disseminated disease.     

Risk Factors for Aspiration in Community-acquired Pneumonia: Analysis of a Hospitalized UK Cohort

Background

There is a move toward finding clinically useful “phenotypes” in community-acquired pneumonia: groups of patients displaying distinct clinical characteristics, microbiology, and prognosis. Aspiration pneumonia is an intuitive clinical phenotype; however, to date there are no recognized diagnostic criteria, and data regarding outcomes in suspected aspiration are limited.

Methods

An observational study of 1348 patients hospitalized with community-acquired pneumonia in the United Kingdom examined both short- and long-term outcomes for patients at risk of aspiration pneumonia. Patients were defined as “at risk” in the presence of chronic neurologic disorders, esophageal disorders and dysphagia, impaired conscious level, vomiting, or witnessed aspiration. The primary outcome was 30-day mortality. Secondary outcomes included 1-year mortality, readmissions, and recurrent pneumonia within 1 year.

Results

Some 13.8% of the cohort were classified as “at risk of aspiration.” These patients were older (median age, 74 years [interquartile range, 60-84] vs 66 years [interquartile range, 49-77]; P < .0001) and more likely to have comorbidities (chronic liver disease 11.3% vs 3.7%, P < .0001; congestive heart failure 28% vs 17.1%, P = .0004; and stroke 26.9% vs 9.5%, P < .0001). Patients at risk of aspiration pneumonia had a poorer short-term outcome (30-day mortality 17.2% vs 7.7%, P < .0001), but after adjusting for their greater severity of illness and comorbidities this difference was not significant (odds ratio 1.05; 95% confidence interval [CI], 0.63-1.76; P = .8). However, patients with aspiration risk factors were at greater risk of poor long-term outcomes with increased 1-year mortality (hazard ratio [HR], 1.73; 95% CI, 1.15-2.58), increased risk of rehospitalization (HR, 1.52; 95% CI, 1.21-1.91), and a strong association with recurrent admissions with pneumonia (HR, 3.13; 95% CI, 2.05-4.78) after multivariable adjustment.

Conclusions

Using risk factors to identify patients at risk of aspiration pneumonia identifies a distinct clinically useful phenotype of patients with greater severity of disease and poorer long-term outcomes.     

Subgingival controlled release of antimicrobial agents in the treatment of periodontal disease

Local drug delivery of antimicrobics by sustained release delivery systems can be used to treat periodontal disease. Advantages of these systems may include biodegradation of the system, maintaining high levels of antibiotic in the gingival crevicular fluid (GCF) for a sustained period of time and ease of use with high patient acceptance. This review will identify human in vivo clinical and microbiological studies. Sustained release formulations, application methods, clinical results and microbiological effects are discussed.     

A comparison of the in vivo antibacterial effects of 'OpSite', 'Tegaderm' and 'Ensure' dressings

Three semi-permeable polyurethane dressings, 'Ensure', 'OpSite' and 'Tegaderm', were tested for their ability to prevent the increase in bacterial population under naturally hydrated, occluded volar forearm skin. Only 'OpSite' inhibited the bacterial multiplication in these tests. It is concluded that in the practical situation, 'OpSite' could well confer a greater margin of safety.     

Assessment of burn wound sepsis by swab, full thickness biopsy culture and blood culture--a comparative study

Fifty patients with burns ranging from 30 to 50 per cent of their body surface area were monitored for sepsis throughout their hospital stay using swab, blood and full thickness biopsy culture techniques. The relative merits of these techniques in the diagnosis of burn wound sepsis were evaluated. Only 62.5 per cent of the patients with a positive surface culture showed signs of clinical sepsis, while 87.5 per cent of the patients with significant bacterial count on biopsy culture showed signs of clinical sepsis. A decrease in bacterial count on follow up correlated with clinical improvement while a count of 10(8) orgs/gm indicated a bad prognosis. Wound surface cultures, though the simplest method gave poor indication of the organisms invading into the burn wound. Blood cultures were of only prognostic value. Full thickness biopsy culture and quantification of the number of bacteria in the burn wound was felt to be the best method for rapid diagnosis and for assessing the progress of burn wound infection.     

Comparative Study of Cefamandole versus Ampicillin plus Cloxacillin: Prophylactic Antibiotics in Cardiac Surgery

A randomized, prospective study of the efficacy of cefamandole naftate versus a combination of ampicillin and cloxacillin was undertaken in 109 adult patients operated on in Leeds during 1979. Sixty patients underwent valve replacement, and 49 had either aortocoronary bypass grafts or other forms of open-heart operation. The two groups matched well in age, sex, and type of operation. One gram of either antibiotic was given intravenously during the induction of anesthesia and every 6 hours thereafter for 48 hours. Two additional grams of antibiotic were placed in the prime of the heart-lung machine.The overall rate of infection was 7.5% for the entire series, with 1.7% for the group given cefamandole and 13.7% for the group given ampicillin plus cloxacillin (p < 0.05). The only patient with infection in the former group (1.7%) had sternal wound involvement. Major sternal wound infection occurred in 3 (5.9%) patients in the latter group. All wound infections were caused by Staphylococcus aureus. In 2 of these patients (ampicillin plus cloxacillin group) the infection proceeded to endocarditis. Urinary and respiratory tract infections occurred in 1.9% and 5.9%, respectively, of patients given ampicillin plus cloxacillin. The duration of hospital stay was shorter in the cefamandole group. The results of this study demonstrated that cefamandole confers effective prophylaxis in cardiac operations.     

Occult microbial contamination in tissue expansion

Summary In 38 patients who underwent tissue expansion, microbiology swabs from the implant bed and expander lumen were routinely cultured at the time of expander removal. Of the 61 cultures performed 42% were positive. Along with various potentially pathogenic bacteria and skin commensales, staphylococci were the strains isolated most frequently. In only two cases this contamination correlated with a clinically apparent infection or expander exposure. The results suggest that bacterial contamination is a common feature in expansion, which does not necessarily lead to an infection and failure of the method. Infection is predominantly a problem of impaired local resistance, especially microcirculatory derangements.     

Change and stability in cellular organisms.

The living cell is characterized by both its potential for change and its tendency towards a stable state. The interaction between the DNA information system and the metabolic steady state is described. A model based on this interaction leads to the conclusions that change can only be initiated from the environment but that the direction of any change is determined by the cell.