Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive

Contemporary operative caries management:consensus recommendations on minimally invasive caries removal

The International Caries Consensus Collaboration (ICCC) presented recommendations on terminology, on carious tissue removal and on managing cavitated carious lesions. It identified 'dental caries' as the name of the disease that dentists should manage, and the importance of controlling the activity of existing cavitated lesions to preserve hard tissues, maintain pulp sensibility and retain functional teeth in the long term. The ICCC recommended the level of hardness (soft, leathery, firm, and hard dentine) as the criterion for determining the clinical consequences of the disease and defined new strategies for carious tissue removal: 1) Selective removal of carious tissue - including selective removal to soft dentine and selective removal to firm dentine; 2) stepwise removal - including stage 1, selective removal to soft dentine, and stage 2, selective removal to firm dentine 6 to 12 months later; and 3) non-selective removal to hard dentine - formerly known as complete caries removal (a traditional approach no longer recommended). Adoption of these terms will facilitate improved understanding and communication among researchers, within dental educators and the wider clinical dentistry community. Controlling the disease in cavitated carious lesions should be attempted using methods which are aimed at biofilm removal or control first. Only when cavitated carious dentine lesions are either non-cleansable or can no longer be sealed, are restorative interventions indicated. Carious tissue is removed purely to create conditions for long-lasting restorations. Bacterially contaminated or demineralised tissues close to the pulp do not need to be removed. The evidence and, therefore these recommendations, supports minimally invasive carious lesion management, delaying entry to, and slowing down, the destructive restorative cycle by preserving tooth tissue, maintaining pulp sensibility and retaining the functional tooth-restoration complex long-term

Sexual Hormone Fluctuation in Chinchillas.

The data about chinchilla (Chinchilla laniger) reproduction are limited and in some cases discordant. The aim of this study was to monitor the sexual hormone fluctuation by fecal progesterone level and colpocytology analysis by vaginal smears in order to evaluate the different phases of the oestrus cycle. Twenty-four non pregnant chinchillas aged from 1 to 4 years old and subdivided in three groups were monitored. In contrast with findings reported in other study, the high values of progesterone recorded in autumn suggested the presence of a ciclicity also in this period. The data indicate that chinchilla presents a continuous cycle

Sexual hormone fluctuation in chinchillas

The data about chinchilla (Chinchilla laniger) reproduction are limited and in some cases discordant. The aim of this study was to monitor the sexual hormone fluctuation by fecal progesterone level and colpocytology analysis by vaginal smears in order to evaluate the different phases of the oestrus cycle. Twenty-four non pregnant chinchillas aged from 1 to 4 years old and subdivided in three groups were monitored. In contrast with findings reported in other study, the high values of progesterone recorded in autumn suggested the presence of a ciclicity also in this period. The data indicate that chinchilla presents a continuous cycle.[...

Oral and dental findings in a child with growth hormone insensitivity syndrome

Growth hormone insensitivity syndrome, also known as Laron syndrome, is an autosomal recessive disorder caused by defects the of growth hormone receptor gene and may lead to increased growth hormone levels. This syndrome's main clinical features are: dwarfism; acromicria; organomicria; cervical spinal stenosis; early osteoarthritic changes of the atlantoaxial joint; small oropharynx; decreased growth velocity; insulin resistance; hypoglycemia; delayed skeletal maturation and osteoporosis; and muscular and central nervous tissue underdevelopment. The facial bones, especially sphenoid and mandibular, are also underdeveloped. No reports of the incidence of growth hormone insensitivity syndrome in the population are available in the literature. The purpose this case report was to describe oral findings and particularities of dental treatment in a child with growth hormone insensitivity syndrome

Efficacy of a nurse-led email reminder program for cardiovascular prevention risk reduction in hypertensive patients: A randomized controlled trial

BACKGROUND: Many strategies have been evaluated to improve the prevention and control of cardiovascular (CVD) risk factors. Nursing telephonic and tele-counseling individualized lifestyle educational programs have been found to improve blood pressure control and adherence to lifestyle recommendation. This study tested the efficacy of a nurse-led reminder program through email (NRP-e) to improve CVD risk factors among hypertensive adults. METHODS: All participants received usual CVD prevention and a guideline-based educational program. Subjects in the NRP-e group also received weekly email alerts and phone calls from a nurse care manager for 6 months. Emails contained a reminder program on the need for adherence with a healthy lifestyle based upon current guidelines. Follow-up visits were scheduled at 1, 3 and 6 months after enrollment; randomization was made centrally and blood samples were evaluated into a single laboratory. RESULTS: The final sample consisted of 98 (control) and 100 (NRP-e) subjects (mean age 59.0 ± 14.5 years; 51.0% males). After 6 months, the following CVD risk factors significantly improved in both groups: body mass index, alcohol and fruit consumption, cigarette smoking, adherence to therapy hours, systolic and diastolic blood pressure, fasting blood glucose, low-density lipoproteins (LDL) and total cholesterol, triglycerides, and physical activity. In the NRP-e group, however, the prevalence of several behaviors or conditions at risk decreased significantly more than in the control group: obesity (-16%), low fruit consumption (-24%), uncontrolled hypertension (-61%), LDL (-56%), and total cholesterol (-40%). CONCLUSIONS: The NRP-e improved a range of CVD risk factors. The program had low costs, required only an average of <20 min per day in addition to normal practice, and may deserve further evaluation for the inclusion among existing care management approaches