Clinical parameters associated with periodontitis in untreated persons

The purpose of this study was to investigate the relationship between clinical parameters and periodontitis in a population receiving no regular prophylactic dental care. From a sample of 164 adult rural and urban Tanzanian subjects aged between 30 and 44 years, 16% were identified with periodontitis according to the criteria that at least three teeth had a probing depth > or = 6 mm. Subjects with periodontitis in this sample exhibited a much higher bleeding tendency (at sites where periodontal pockets and did not exist) than subjects without periodontitis, but dental plaque scores were comparable. Sensitivity and specificity values and odds ratios indicated a strong association between bleeding on probing and the presence of periodontitis. This may indicate that people from a population deprived of regular dental care with a high tendency of bleeding on probing are more prone to develop periodontitis. Whether bleeding on probing could serve as a marker in this population to identify subjects who develop future periodontal destruction has to be explored through further longitudinal studies.     

Titer and subclass distribution of serum IgG antibody reactive with Actinobacillus actinomycetemcomitans in localized juvenile periodontitis

Most patients with localized juvenile periodontitis (LJP) manifest serum IgG antibodies specifically reactive with antigens of Actinobacillus actinomycetemcomitans serotype b (Aa-b). Whether these antibodies are protective, destructive, or irrelevant to the progress of the disease remains unclear. We report results of studies aimed at assessing the subclass IgG responses in 35 LJP patients and 35 periodontally normal control subjects using well-characterized monoclonal antibody subclass reagents in an enzyme-linked immunosorbent assay. Our data show that the mean value for total IgG reactive with antigens of Aa-b was more than sevenfold higher for patients than for normal control sera (2349.6 micrograms/ml for patients vs 332.2 micrograms/ml for controls). Individual patients and control subjects were classified as high- or low-titer, using twice the median value for total anti-Aa-b IgG in control sera as the cutoff. Of 35 patients, 26 (74%) were high-titer, and 9 (26%) were low-titer. This compares to 5 normal control subjects (14%) high-titer and 30 (86%) low-titer. IgG2 accounted for the major quantitative response in both patients and control subjects. Indeed, the mean IgG2 values for both concentration and percentage of total specific IgG were greater than the combined values for specific anti-Aa-b IgG1, IgG3, and IgG4. Of the 26 high-titer sera, IgG2 predominated in 24, with IgG1 and IgG3 predominating in 1 each; IgG2 predominated in only 2 of the low-titer sera.     

Galactose oxidase-glucan binding domain fusion proteins as targeting inhibitors of dental plaque bacteria

In order to inhibit the growth of bacteria present in the human oral cavity, a novel system which targets antimicrobial agents to dental plaque has been developed. This system involves a hybrid protein consisting of a peptide expressing the bactericidal properties of galactose oxidase (GAO) fused to the glucan binding domain (GBD) of the Streptococcus mutans glucosyltransferase-S enzyme. A gene encoding GAO from the fungus Fusarium sp. has been inserted into an Escherichia coli expression vector and fused to sequences encoding the GBD, which binds to the glucans synthesized by oral streptococci. Bacterial extracts expressing the hybrid protein were tested for their ability to target the GAO activity to an in vitro plaque model consisting of streptococcal cells bound to microtiter plate wells. The binding of the hybrid protein to the streptococcal cells through its GBD and the dependence of binding on the production of glucans by bacteria were demonstrated. Furthermore, killing of three different species of oral streptococci by bound hybrid protein in conjunction with the galactose-lactoperoxidase-iodide cytotoxic system has been demonstrated. These results suggest a novel strategy for controlling dental plaque formation as well as dental caries in humans.     

Reduced CSF IgG in patients treated with phenytoin (diphenylhydantoin)

In the CSF's from 13 out of 30 phenytoin-treated patients the IgG concentrations were lower than the lowest amont 20 controls, while only 3 out of 37 patients with brain lesions without epilepsy had so low IgG value. Titers of IgG antibodies to rabbit erythrocytes were similar in the three groups. It should be kept in mind, when evaluating results of IgG determinations in clinical neurology, that reduced IgG may be a consequence of phenytoin treatment. Reduced IgG concentrations without reduction of an antibody belonging to the IgG class indicate that the suppression of immunoglobulin synthesis by phenytoin may be selective.     

Supervised exercise training improves cardiopulmonary fitness in HIV-infected persons

We attempted to measure cardiopulmonary effects, CD4 counts, and perceived sense of well-being in 25 individuals moderately to severely immunocompromised from HIV infection (mean entry CD4 count = 144.microliters-1) before and after a 24-wk program of exercise training. Only six subjects completed the 24-wk program. All six showed evidence of a training effect. Statistically significant improvements were seen in maximal oxygen consumption (VO2max), oxygen pulse, and minute ventilation. Submaximal exercise performance improved significantly by 12 wk in the 10 individuals available for testing: decreases were seen in heart rate, rate pressure product, and rate of perceived exertion. White blood cell counts and T-lymphocyte subsets were stable at 12 and 24 wk in the subjects available for testing. High depression/anxiety scores on a mental health inventory (General Health Questionnaire) correlated with low CD4 counts. Scores did not correlate with compliance with the exercise program. There was a trend (P < 0.10) for scores to improve over time among those individuals who attended > or = 80% of scheduled exercise sessions. We conclude that exercise training is feasible and beneficial for some HIV-infected individuals.     

Reduced mercury vapor release from dental amalgams prepared with binary Hg-in liquid alloys

For the past ten years, the amounts of mercury vapor released from dental amalgams and the possibility of side-effects caused by these amounts have been discussed. Although no adverse health effects have been substantiated from these minute amounts, besides rare cases of allergies, this release should be reduced. The aim of this study was to reduce the mercury evaporation from a high-copper amalgam during setting by triturating the alloy powder with binary Hg-In liquid alloys having various indium concentrations set at 0, 5, 10, 20, 30, 40, and 50 wt%. Specimens (n = 4) were made for each amalgam according to ANSI/ADA Specification #1 and placed into a measuring chamber kept at 36.5 +/- 0.5 degrees C, through which a continuous air flow of 0.75 L/min was pumped. The total mercury release was measured during the setting period, according to the method described by Ferracane et al. (1992). Four additional specimens were prepared from a modified 14% Indisperse amalgam powder for the purpose of comparison. The results showed that the release of mercury vapor decreased with increasing indium concentrations, and that the amalgams made with the Hg-In liquid alloy with 10% In or more released significantly less mercury than the modified 14% Indisperse. The method of mixing indium in mercury prior to trituration appeared to be another effective method for reducing mercury evaporation during setting. The reduced mercury release may be explained by a reduction of mercury concentration in the structure, a reduction of vapor pressure for the mercury in the matrix phases, or more efficient formation of a surface oxide layer.     

Gingival state and dental calculus in early-onset periodontitis

This study was undertaken to 1) compare the prevalence of gingival inflammation and dental calculus in adolescents with early-onset periodontitis and their matched controls and 2) assess and compare the relationship between the presence of dental calculus and the extent of gingival bleeding and attachment loss in these subjects. The study group consisted of 1,285 13 to 20 year-old individuals, 651 males and 634 females, selected from a national survey of the oral health of U.S. adolescents in 1986/1987. It included 709 (55.2%) Blacks, 224 (17.4%) Hispanics, and 352 (27.4%) Whites. Eighty-nine subjects had localized or generalized juvenile periodontitis (JP), 218 had incidental attachment loss (IAL), and 978 were without clinical attachment loss (controls). The controls were matched to cases on gender, race, age, and geographic location. The subjects were examined clinically to assess the percentage of sites with gingival bleeding and supragingival calculus only and subgingival calculus with or without supragingival calculus. The IAL and JP groups had significantly more gingival bleeding and subgingival calculus than the controls. Also, the JP group had significantly higher prevalence of both conditions than the IAL group. The percentage of sites with supragingival calculus was not different between the groups, but varied by ethnicity. Hispanics with JP had the highest percentage of sites with gingival bleeding and subgingival calculus, and the lowest percentage of sites with only supragingival calculus. The results demonstrate that gingival inflammation and subgingival calculus are associated with early periodontal breakdown, and contradict earlier reports of early-onset periodontitis not being associated with these factors.     

Depressed mood does not explain neuropsychological deficits in HIV-infected persons.

The relationship of depressed mood to cognitive disturbance in HIV infection was examined in a sample of 139 homosexual men. Ss were grouped according to the classification of the Centers for Disease Control: 39 were in Group IV, 62 were in Group II or Group III, and 38 were HIV-negative. Ss completed the Profile of Mood States and 10 neuropsychological tests. Analysis employing a classification approach indicated that, although symptoms of depression and neuropsychological impairment were more common in Ss who were HIV-positive, particularly those classified as Group IV, there were no systematic relationships between depression and neuropsychological impairment. Depressed mood and cognitive disturbance each seem to have unique associations to HIV illness status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fluorescence of dental calculus from cats, dogs, and humans and of bacteria cultured from dental calculus

Recently we reported that feline and canine dental calculus fluoresced pink to red under long wavelength ultraviolet light due to the presence of porphyrin. Here we report the observation of such fluorescence in 30 of 30 cats, 30 of 30 dogs, and 8 of 13 supragingival samples and 5 of 5 subgingival samples of humans. The fluorescence spectra of the calculus dissolved in 9 M HCl show that it is due to three distinct metal-free porphyrins. Similar fluorescence is obtained from bacterial cultures grown from calculus deposits of cats and dogs and bacteria grown on blood agar containing hemin and vitamin K1. The results of the bacterial culture study suggest that the metal-free porphyrin is produced by bacteria in the mouth. The clinical observation of fluorescence can be used for diagnosis.     

Predictors of survival in HIV-infected persons with 50 or fewer CD4 cells/mm3

The objective of this study was to identify prognostic factors for survival in patients with pretreatment CD4 < or =50 cells/mm3 treated with nucleoside analogs, and to develop and validate a mortality risk model based on these factors. The design of the study consisted of retrospective analysis of AIDS Clinical Trials Group (ACTG) protocols 116a, 116b/117, 155, and 118. The setting was the multicenter AIDS Clinical Trials Group. The patients were HIV-infected with pretreatment CD4 < or =50 cells/mm3 and various degrees of prior zidovudine (ZDV) use. Double-blind, three-arm randomized control trials ACTG 116a and ACTG 116b/117 compared ZDV with didanosine (ddI). ACTG 155 compared ZDV with zalcitabine or combination therapy. Our validation study, ACTG 118, compared the effects of three different doses of ddI on survival. The main outcome measures were survival and mortality. The three studies combined enrolled 699 patients with entry CD4 T-lymphocyte counts of < or =50 cells/mm3. Forty percent of patients died during follow-up, with a median survival of 19.7 months. Multivariate analysis showed shorter survival at p < 0.0001 with lower CD4 count (relative hazard [RH] = 0.98) and lower hemoglobin level (RH = 0.81). Other factors included older age (RH = 1.03), male gender (RH = 1.70), Hispanic ethnicity (RH = 1.68), and symptomatic disease stage (RH = 2.06). Our predictive mortality risk model differentiated well patients with differing risks of mortality. When the risk model was applied to ACTG 118, the validation data set, the identified prognostic factors could distinguish patients with varying risks of death (p < 0.001, stratified log-rank test). These results demonstrate that CD4 T-lymphocytes counts < or =50 cells/mm3 should not be considered a precursor of imminent death; considerable variability in survival exists in severely immunocompromised patients. Our identification of prognostic indicators for survival can aid clinicians and patients in management of their disease and researchers in design of future clinical trials.     

Reduced binding and phagocytosis of Pneumocystis carinii by alveolar macrophages from persons infected with HIV-1 correlates with mannose receptor downregulation

The macrophage mannose receptor, a pattern recognition molecule and component of innate immunity, mediates binding and phagocytosis of Pneumocystis carinii and likely represents an important clearance mechanism in the lungs of immunocompetent hosts. The purpose of this study was to examine the ability of alveolar macrophages from HIV-infected individuals to bind and phagocytose P. carinii, and to investigate the role of the macrophage mannose receptor in mediating this interaction. Compared with healthy individuals, alveolar macrophage phagocytosis of P. carinii from HIV+ persons was reduced up to 74% (P = 0.02), primarily reflecting a reduction in the number of organisms associated with each macrophage (P = 0.019). Furthermore, macrophages from HIV+ individuals demonstrated up to an 80% (P < 0.05) reduction in mannose receptor surface expression and endocytosis. Mannose receptor affinity was unaltered, and mRNA levels were modestly reduced (P < 0.05). Cells from HIV+ individuals with CD4(+) counts < 200 cells/mm3 (representing individuals at high clinical risk for P. carinii pneumonia) demonstrated the lowest levels of P. carinii phagocytosis and mannose receptor endocytosis. In vitro HIV infection of alveolar macrophages from healthy individuals reduced mannose receptor endocytosis to 53.2% (P < 0.05) and P. carinii binding and phagocytosis to 67.4% (P < 0.05) of control. Our studies suggest that HIV infection may alter innate immunity in the lungs, and that impaired alveolar macrophage mannose receptor-mediated binding and phagocytosis of P. carinii may contribute to the susceptibility of HIV-infected individuals to this opportunistic pulmonary pathogen.     

Short-course prophylaxis against tuberculosis in HIV-infected persons. A decision and cost-effectiveness analysis

Kidney ectopeptidases play an important role in the metabolism of different peptides. They activate precursor proteins or inactivate peptides including hormones, cytokines, vasoactive peptides (angiotensin II, endothelin), neuroendocrine hormones, changing local concentration in active peptides. Kidney ectopeptidase regulate cell proliferation, adhesion, matrix synthesis, cell signaling, cell activation, differentiation and cell-cell communication. The role of four major ectopeptidases (aminopeptidase A and N, dipeptidylpeptidase IV, and neutral endopeptidase) is presented.     

Screening for distal sensory peripheral neuropathy in HIV-infected persons in research and clinical settings

OBJECTIVE: To determine the accuracy of a screening examination for distal sensory peripheral neuropathy (DSPN) performed by nonphysician clinicians and to explore the associations between DSPN and clinical features in HIV-infected persons. METHODS: A case-control study of a volunteer sample of 226 HIV-infected individuals was performed. An interview, focusing on risks and symptoms of DSPN, and a screening neurologic examination were performed. RESULTS: Compared with the neurologist's examinations, the clinicians' examination was sensitive (92 to 95%) but not as specific (71 to 84%) for the diagnosis of DSPN. After excluding 27 patients with confounders, 42 of 199 patients (21%) had DSPN. This was associated significantly with neurotoxic nucleoside antiretroviral use and with more advanced HIV disease. Of the 42 patients with DSPN, 30 (71%) had no neuropathy symptoms. CONCLUSIONS: A brief examination performed by trained nonphysician clinicians can be used to screen for DSPN in HIV-infected persons. Asymptomatic DSPN is common in these individuals.     

Influence of a hypoiodite mouth-wash on dental plaque formation in vivo

This study describes an in vivo inhibition of dental plaque growth after peroxidase-generated hypoiodite (OI-) mouth-washes. After giving up all other usual hygiene procedures nine healthy volunteers washed their mouth using 10 ml of the mouth-wash [H2O2 (0.005%), KI (50 mM) and lactoperoxidase (0.04%)] three times a day for 1 minute for 3 days. The initial oxidation power of this mixture represented 430 +/- 11 microM oxidised cysteine (n = 6), dropping down to 87 +/- 6 microM after the solution was spat out (n = 5). A saline solution served as a negative control, and a 0.2% chlorhexidine digluconate solution as a positive control. Proximal dental plaque between mandibular canine and lateral incisor (left and right) was collected after 3 days using standardized sterile toothpicks, then analysed for ATP and protein content. ATP concentrations dropped to 49% of the control values after OI- rinsing, and to 9% after chlorhexidine rinsing while the protein content dropped to 48% for OI- versus 31% for chlorhexidine. However, when considering the ATP content per protein micrograms, only the decrease to 6% of the initial value in the chlorhexidine testing was significant while the drop to 81% for the OI- testings was not significant. This study points out a negative effect of OI- on plaque growth in vivo.     

Results of culture form colonoscopically obtained specimens for bacteria and fungi in HIV-infected patients with diarrhea

BACKGROUND: The aim of our study was to determine the diagnostic yield of culture for bacteria and fungi from colonic biopsy specimens in 290 consecutive HIV-infected patients with diarrhea. METHODS: During each colonoscopy, three biopsy specimens were homogenized and cultured on media for Salmonella and Shigella and for Campylobacter and Yersinia, on Loewenstein medium and on Sabouraud medium. RESULTS: Cultures were found positive for one (n = 32) or two (n = 5) infectious agents in 37 cases, i.e., in 12.8% of the patients. Bacteria were isolated in 24 cases, and identified as Campylobacter jejunl-coli (n = 14), Salmonella (n = 2), Shigella (n = 1), or Pseudomonas aeruginosa (n = 7). Among the 14 patients with C. jejuni-coli intestinal infection, 11 had normal-appearing mucosa at colonoscopy, and 3 had a concomitant stool culture negative for Campylobacter. Mycobacterial cultures were positive for Mycobacterium avium intracellulare in 6 patients, who were already known as having a disseminated M. avium intracellulare infection from positive blood cultures. Fungal cultures were positive for Candida in 10 cases, without clear clinical significance. CONCLUSIONS: The overall yield of culture for bacterial pathogens from colonic tissue in HIV-infected patients with diarrhea is low, but some individual cases of C. jejuni-coli infections may be detected from colonic tissue culture and not diagnosed by concomitant stool culture.     

The prevalence of oral candidiasis in HIV-infected individuals and dental attenders in Edinburgh

This study prospectively assessed the prevalence of oral candidal carriage and oral candidiasis in known HIV-seropositive individuals (n = 121) and other dental attenders in Edinburgh (n = 614). Candida species were isolated from 57.4% of dental attenders and 93.4% of HIV-seropositive subjects. Clinical evidence of oral candidiasis was observed in 6% and 52% of these groups respectively, erythematous forms of candidiasis being the commonest in both groups.