Oral shedding of human herpesviruses in renal transplant recipients

Abstract

Objective

To describe the shedding profile of human herpesviruses in the saliva of renal transplant recipients.

Methods

This is a prospective case-control study of 50 renal transplant recipients and control group of 50 individuals (non-transplanted and immunocompetent). Mouthwash samples were collected via oral rinse and then submitted to screening for the presence of eight types of herpesviruses by using multiplex PCR. Fisher's exact, chi-square, and Student t tests were used for statistical analysis, and the significance level was set at 5%.

Results

The mean age of the study group was 49.42 ± 12.94 years, 28/50 (56%) were female, and the time elapsed after transplantation was 68.20 ± 67.19 months. Herpes simplex virus 1 (HSV-1) (P = 0.025) and Epstein-Barr virus (EBV) (P = 0.024) were, statistically, more excreted in the saliva of renal transplant recipients compared to control group. Gender (P = 1.00) and age (P = 0.563) did not influence the salivary shedding of herpesviruses in renal transplant recipients. Individuals who excreted varicella-zoster virus in saliva had a shorter mean time of transplantation (22:00 + 2.82 months) (P < 0.001).

Conclusion

Renal transplant recipients excreted herpesviruses more often than controls, especially HSV-1 and EBV, with salivary shedding of herpesviruses being more frequent in patients with recent kidney transplantation.

Clinical relevance

The present findings support other longitudinal studies evaluating the relationship between oral shedding of human herpesviruses and clinical presence of active infection and renal transplant failure.

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Effect of root canal preparation techniques on chlorhexidine substantivity on human dentin: a chemical analysis

Abstract

Objectives

Chlorhexidine binds to dentine to provide sustained action. The aim of the present study was to evaluate and compare the substantivity of chlorhexidine using manual, rotary, and reciprocating systems for root canal preparation.

Methods

Forty-five extracted human single-rooted teeth were used for this study. The samples were divided into three groups (n = 15) according to the instrumentation technique used: manual instrumentation (K-File), rotary instrumentation (ProTaper), and reciprocating instrumentation (Reciproc R25). Chlorhexidine gel (2%) was used as auxiliary chemical substance during root canal preparation. Longitudinal grooves were carved on the free surfaces of the roots, providing two halves of each root and resulting in 30 samples per group. Each group was randomly divided into three subgroups (n = 10), and substantivity was evaluated after 48 h, 7 days, and 30 days of incubation. The amount of CHX (in mg/mL) was measured through reverse-phase high-performance liquid chromatography. Statistical analysis was performed by analysis of variance and the Tukey test for post hoc comparisons (α = 0.05).

Results

The manual did not show a statistical significant difference with rotary instrumentation (P > 0.05), but higher CHX substantivity was recorded in all periods of observation when compared to reciprocating instrumentation (P < 0.05).

Conclusions

The CHX substantivity on human dentine is lowest when using reciprocating compared to manual and rotary instrumentation.

Clinical significance

Using chemical analysis, this study showed that a manual and rotary multi-instrument system results in greater chlorhexidine substantivity on human dentin than a reciprocating single-instrument system.

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Editors / Publication Information

Publication date: 1 September 2017
Source:Appetite, Volume 116





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Cultural Competency Training in Emergency Medicine

Publication date: Available online 1 July 2017
Source:The Journal of Emergency Medicine
Author(s): Oren J. Mechanic, Nicole M. Dubosh, Carlo L. Rosen, Alden M. Landry
BackgroundThe Emergency Department is widely regarded as the epicenter of medical care for diverse and largely disparate types of patients. Physicians must be aware of the cultural diversity of their patient population to appropriately address their medical needs. A better understanding of residency preparedness in cultural competency can lead to better training opportunities and patient care.ObjectiveThe objective of this study was to assess residency and faculty exposure to formal cultural competency programs and assess future needs for diversity education.MethodsA short survey was sent to all 168 Accreditation Council for Graduate Medical Education program directors through the Council of Emergency Medicine Residency Directors listserv. The survey included drop-down options in addition to open-ended input. Descriptive and bivariate analyses were used to analyze data.ResultsThe response rate was 43.5% (73/168). Of the 68.5% (50/73) of residency programs that include cultural competency education, 90% (45/50) utilized structured didactics. Of these programs, 86.0% (43/50) included race and ethnicity education, whereas only 40.0% (20/50) included education on patients with limited English proficiency. Resident comfort with cultural competency was unmeasured by most programs (83.6%: 61/73). Of all respondents, 93.2% (68/73) were interested in a universal open-source cultural competency curriculum.ConclusionsThe majority of the programs in our sample have formal resident didactics on cultural competency. Some faculty members also receive cultural competency training. There are gaps, however, in types of cultural competency training, and many programs have expressed interest in a universal open-source tool to improve cultural competency for Emergency Medicine residents.



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Verb Naming Fluency in Hypokinetic and Hyperkinetic Movement Disorders

Publication date: Available online 1 July 2017
Source:Cortex
Author(s): Ece Bayram, Muhittin Cenk Akbostanci
Cortical motor regions are also considered to play a role in action related language. These regions are affected differently in different types of movement disorders. Parkinson's disease, a hypokinetic movement disorder, has been shown to cause action language disruptions alongside movement deficits. Action language, however has not been investigated in primary cervical dystonia, a hyperkinetic movement disorder. The aim of this study is to investigate whether action language is affected differently in hypokinetic and hyperkinetic movement disorders which have different effects on movements. Thirty patients with Parkinson's disease, thirty with primary cervical dystonia patients and thirty healthy controls were included in the study. Participants performed phonemic, semantic and action fluency tasks. Verbs produced during action fluency were grouped as action and non-action verbs and group differences were investigated. Our results showed that all participants performed similarly in all of the fluency tasks. Mean action content of the verbs produced in action fluency did not differ in between groups. During action fluency, however, whereas healthy controls produced more action verbs than non-action verbs, both patient groups did not have this difference between verb groups. Primary cervical dystonia patients produced less action verbs compared to healthy controls. The lack of action language deficits in Parkinson's disease and only an action verb deficit in primary cervical dystonia without any other action language deficits rejects strong embodiment.



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Room Service Improves Nutritional Intake and Increases Patient Satisfaction While Decreasing Food Waste and Cost

Publication date: Available online 1 July 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Sally McCray, Kirsty Maunder, Renee Krikowa, Kristen MacKenzie-Shalders
BackgroundRoom service is a foodservice model that has been increasingly implemented across health care facilities in an effort to improve patient satisfaction and reduce food waste. In 2013, Mater Private Hospital Brisbane, Australia, was the first hospital in Australia to implement room service, with the aim of improving patient nutrition care and reducing costs.ObjectiveThe aim of this study was to comprehensively evaluate the nutritional intake, plate waste, patient satisfaction, and patient meal costs of room service compared to a traditional foodservice model.DesignA retrospective analysis of quality-assurance data audits was undertaken to assess patient nutritional intake between a facility utilizing a traditional foodservice model and a facility utilizing room service and in a pre−post study design to assess plate waste, patient satisfaction, and patient meal costs before and after the room service implementation.ParticipantsAudit data were collected for eligible adult inpatients in Mater Private Hospital Brisbane and Mater Hospital Brisbane, Australia, between July 2012 and May 2015.Main outcome measuresThe primary outcome measures were nutritional intake, plate waste, patient satisfaction, and patient meal costs.Statistical analyses performedIndependent samples t-tests and χ² analyses were conducted between pre and post data for continuous data and categorical data, respectively. Pearson χ² analysis of count data for sex and reasons for plate waste for data with counts more than five was used to determine asymptotic (two-sided) significance and n-1 χ² used for the plate waste analysis. Significance was assessed at P<0.05.ResultsThis study reported an increased nutritional intake, improved patient satisfaction, and reduced plate waste and patient meal costs with room service compared to a traditional foodservice model. Comparison of nutritional intake between a traditional foodservice model (n=85) and room service (n=63) showed statistically significant increases with room service in both energy (1,306 kcal/day vs 1,588 kcal/day; P=0.005) and protein (52 g/day vs 66 g/day, P=0.003) intake, as well as energy and protein intake as a percentage of requirements (63% vs 75%; P=0.024 and 65% vs 85%; P=0.011, respectively). Total mean plate waste decreased from 29% (traditional foodservice model) to 12% (room service) (P<0.001). Patient satisfaction ratings indicated improvement with room service across all Press Ganey meal scores: 68th to 86th percentile overall; 64th to 95th percentile for "quality of food"; and 60th to 99th percentile for "flavor of food." Evaluated during comparable times of the year, patient meal costs decreased by 15% with room service.ConclusionsA patient-centered foodservice model, such as room service, can improve patient nutritional intake and enhance patient satisfaction in a budget constrained health care environment.



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Development, Construct Validity, and Reliability of the Questionnaire on Infant Feeding: A Tool for Measuring Contemporary Infant-Feeding Behaviors

Publication date: Available online 1 July 2017
Source:Journal of the Academy of Nutrition and Dietetics
Author(s): Elizabeth J. O'Sullivan, Kathleen M. Rasmussen
BackgroundThe breastfeeding surveillance tool in the United States, the National Immunization Survey, considers the maternal−infant dyad to be breastfeeding for as long as the infant consumes human milk (HM). However, many infants consume at least some HM from a bottle, which can lead to health outcomes different from those for at-the-breast feeding.ObjectiveOur aim was to develop a construct-valid questionnaire that categorizes infants by nutrition source, that is, own mother's HM, another mother's HM, infant formula, or other and feeding mode, that is, at the breast or from a bottle, and test the reliability of this questionnaire.DesignThe Questionnaire on Infant Feeding was developed through a literature review and modified based on qualitative research. Construct validity was assessed through cognitive interviews and a test−retest reliability study was conducted among mothers who completed the questionnaire twice, 1 month apart.Participants/settingCognitive interviews were conducted with ten mothers from upstate New York between September and December 2014. A test−retest reliability study was conducted among 44 mothers from across the United States between March and May 2015.Main outcome measuresEquivalence of questions with continuous responses about the timing of starting and stopping various behaviors and the agreement between responses to questions with categorical responses on the two questionnaires completed 1 month apart.Statistical analyses performedReliability was assessed using paired-equivalence tests for questions about the timing of starting and stopping behaviors and weighted Cohen's κ for questions about the frequency and intensity of behaviors.ResultsReliability of the Questionnaire on Infant Feeding was moderately high among mothers of infants aged 19 to 35 months, with most questions about the timing of starting and stopping behaviors equivalent to within 1 month. Weighted Cohen's κ for categorical questions indicated substantial agreement.ConclusionsThe Questionnaire on Infant Feeding is a construct-valid tool to measure duration, intensity, and mode of infant HM consumption and duration of maternal HM production that is reliable within 19 to 35 months postpartum. Criterion-validity testing of these questions will improve the utility of the Questionnaire on Infant Feeding as a surveillance tool.



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