Ebola virus infection among western healthcare workers unable to recall the transmission route

Introduction. During the 2014-2016 West-African Ebola virus disease (EVD) outbreak, some HCWs from Western countries became infected despite proper equipment and training on EVD infection prevention and control (IPC) standards. Despite their high awareness toward EVD, some of them could not recall the transmission routes. We explored these incidents by recalling the stories of infected Western HCWs who had no known directly exposures to blood/bodily fluids from EVD patients. Methodology. We carried out conventional and unconventional literature searches through the web using the keyword "Ebola" looking for interviews and reports released by the infected HCWs and/or the healthcare organizations. Results. We identified fourteen HCWs, some infected outside West Africa and some even classified at low EVD risk. None of them recalled accidents, unintentional exposures, or any IPC violation. Infection transmission was thus inexplicable through the acknowledged transmission routes. Conclusions. We formulated two hypotheses: inapparent exposures to blood/bodily fluids or transmission due to asymptomatic/mildly symptomatic carriers. This study is in no way intended to be critical with the healthcare organizations which, thanks to their interventions, put an end to a large EVD outbreak that threatened the regional and world populations

Síndrome de boca ardiente: estudio de la psicoterapia, medicación con ácido alfa- lipoico y combinación de terapias

En este estudio de 192 personas sanas con Síndrome de boca ardiente, se analizó la eficacia del control de los síntomas de la psicoterapia sola durante dos sesiones semanales de 1 hora durante dos meses, del ácido alfa lipoico (ALA, ácido tioctico, Tiobec) 600 mg al día durante dos meses, y de la combinación de la psicoterapia y los 600 mg / día de ALA durante 2 meses. Los controles solo recibieron placebo. RESULTADOS. Se obtuvo el mayor beneficio con la terapia combinada. La combinación de los tratamientos con psicoanálisis y ácido alfa lipoico (ALA, acido tioctico, Tiobec 600 mgr al día), durante 2 meses fue significativamente más beneficiosa que el psicoanálisis solo durante dos sesiones semanales de una hora durante dos meses ( p< 0.0005) o el ALA 600 mgr al día solo, durante dos meses (p< 0,0005). CONCLUSIÓN. Los resultados sugieren que el ácido alfa lipoico podría complementar la psicoterapia y ser una alternativa aceptable a los fármacos psicoactivos, por lo que estudios de comparación de ambas alternativas están actualmente justificados.-Objective and study design This open study of 192 otherwise healthy persons with burning mouth syndrome, examined the efficacy on control of symptoms of psychotherapy alone with two hour sessions weekly for two months; alpha lipoic acid (ALA, tioctic acid; Tiobec) 600 mg/ day alone for two months; or combination therapy of psychoanalysis and 600mg/day ALA for two months. Controls received placebo alone. -Results Most benefit was obtained with combination therapy. Combination therapy of psychoanalysis and alpha lipoic acid (ALA , tioctic acid; Tiobec. 600mg/day) for two months gave most benefit and significantly more than psychoanalysis alone for two 1 hour sessions weekly for two months (p<0.0005), or ALA 600 mg/day alone for two months (p<0.0005) . -Conclusion The present results suggest that alpha lipoic acid may complement psychotherapy and can be an acceptable alternative to psychoactive agents, but trials to compare the two approaches are now warranted

Dentifrices : an update

Objectives; The objective of this paper was to review the published evidence concerning the efficacy and potential for adverse reactions of modern dentifrices toothpastes. Data sources; Publications cited on MEDLINE since 1990. Some further pre-1990 publications are also referenced. Data selection; Studies concerning the efficacy of dentifrices and their components and any related putative adverse incidents. Data extraction; Papers were scrutinised for scientific and trial data. Data synthesis; Data concerning the efficacy of dentifrice components were summarised. Conclusions; The efficacy of fluoride salts in dentifrices in reducing dental caries is well established. Toothpastes, containing triclosan, are effective in improving plaque control, gingivitis and periodontal health. Other toothpaste formulations are effective in reducing the formation of calculus, extrinsic tooth stain, dentine sensitivity and oral malodour. The consumer now has available a range of toothpastes which deliver oral health benefits. Adverse reactions to toothpastes are rare but should be considered in unexplained skin or respiratory allergies and gingival or lip lesions

Oral mucosal precancer and cancer: a helpful discriminating clinical tool

The authors have collaborated with many colleagues in several countries in formulating a useful and practical clinical tool for evaluating oral mucosal findings on routine examination. Consideration of several factors including history, evolution of positive findings and clinical information allows placement of examination results into one of three categories which are graded by a color scheme along a spectrum of concerns (green to red, or no concern to serious concern). Afforded to the clinician is a straightforward grading system as a starting point for office end clinic use for all patients

Spindle cell lipoma of the floor of the mouth : a case report

A sessile swelling in the floor of the mouth appeared three years ago in a 29-year old Caucasian female located laterally to the opening of the right duct of Wharton. The mass covered by normal looking mucosa exhibited slight growth since then. After excision, histological examination revealed the presence of a tumor formed by areas of mature adipose cells interspersed with extensions of tightly disposed fusiform fibroblasts immunoreactive for vimentin and CD-34. There were foci of concentric fibroblasts forming dense whorls. When large these conglomerates exhibited chondrocytes in the center. Mast-cells were not rare throughout the fibroblastic areas. No signs of malignancy occurred. These features led to the diagnosis of a spindle cell lipoma with chondrous metaplasia. The relative rarity of such a tumor in this location, especially in the chondrous variety, was considered worth of presentation, while the differential diagnosis with other intraoral tumors, namely mucoceles, dermoid cysts, mesenchimomas, fibromas and myxomas of the floor of the mouth, is discussed

Burning mouth syndrome (BMS) : evaluation of thyroid and taste

Background Burning mouth syndrome (BMS) is a chronic, intraoral burning sensation seen mainly in middle-aged and post-menopausal females, without identifiable oral lesions or abnormal laboratory findings, but often associated with psychogenic disorders such as depression. The latter can have a range of causes, including hormonal. Objective Since there may be connections between BMS, psychogenic changes, hormonal changes and taste abnormalities , we have examined aspects of taste and thyroid function.. Patients and methods We selected 50 patients with BMS (study group) and 50 healthy subjects (control group) and analysed their ability to taste bitter, acid and spicy substances and analysed their thyroid function and Undertook thyroid echography. Results Taste sensation was normal in all controls. However, 30 of the patients with BMS reported ageusia for bitter taste and 2 had ageusia for acid. The use of pepper sauce ( Tabasco®) (spicy substance) produced a strong burning to the tongue in 28 patients of the BMS group but only in 10 controls. No control patients showed abnormality of thyroid function or echograpic abnormality. Five patients in the BMS group had biochemical evidence of hypothyroidism, 4 patients had raised levels of thyroid autoantibodies and, of the 41 remaining BMS patients, most (34) had thyroid echographic changes indicative of nodularity. Conclusions Hypothyroidism may be responsible for a negative influence on taste and consequent increase in trigeminal sensorial sensation (tactile, thermal and painful sensation)

The face of Ebola: changing frequency of haemorrhage in the West African compared with Eastern-Central African outbreaks

BACKGROUND: The West-African (WA) Zaire Ebolavirus disease (EVD) outbreak was characterized by an exceptionally high number of cases and deaths as compared with the Eastern-Central African (ECA) outbreaks. Despite the Zaire Ebolavirus being the most lethal for humans, case-fatality rate, close to 80 % in ECA outbreaks, almost halved to 47 % in Guinea-Liberia-Sierra Leone (WA). Such an improvement was due to the remarkable implementation of international humanitarian aids. Some studies also suggested that the long human-to-human transmission cycle occurred in WA, gave rise to human adaptation and consequent immune escape. Haemorrhage, the main feature in seriously infected EVD patients, is due to the immune system that triggers the infected endothelial cells which expose the spike-like glycoprotein (GP) of the virion on their surface. If the human adaptation hypothesis holds true, the proportion of EVD patients with haemorrhage in the WA outbreak should be lower than in the ECA outbreaks due to immune escape. Therefore, the aim of this meta-analysis was to compare the relative frequencies of three typical haemorrhagic symptoms (conjunctival -CB, nasal -NB, gingival -GB- bleedings) in the ECA and WA outbreaks. METHODS: Literature searches were performed through PubMed and Scopus using generic keywords; surveys including at least ten patients reporting CB, NB, GB relative frequencies were extracted and split into ECA and WA. The meta-analytical methods chosen were based on the levels of between-study heterogeneity and publication bias. Pooled CB, NB, GB relative frequencies in ECA and WA were estimated and compared. Subgroup analysis including only studies on Zaire Ebolavirus also was performed. RESULTS: Fifteen studies (10 ECA, 5 WA) were located with 4,867 (CB), 3,859 (NB), 4,278 (GB) EVD patients overall. GB pooled relative frequency was 45.3 % (95 % confidence interval -95 CI, 34.7-56.1 %) and 18.0 % (95 CI, 6.0-34.5 %), in ECA and WA; NB was 10.6 % (95 CI, 5.7-16.8 %) and 1.3 % (1.0-1.8 %); GB was 24.2 % (95 CI, 11.9-39.2 %) and 1.9 % (95 CI, 1.4-2.4 %). Subgroup analysis confirmed these results. CONCLUSIONS: During the WA outbreak the relative frequency of GB decreased by two thirds, while NB and GB almost disappeared, suggesting that the Zaire Ebolavirus human adaptation hypothesis is plausible

Espectro de las manifestaciones orales de VIH/SIDA en la región de Perm (Rusia) e identificación de lesiones orales linguales ulceronecrotizantes inducidas

-Objetivo: estudiar la frecuencia y el espectro de las manifestaciones orales de consumidores de drogas infectados por VIH en la región de Perm. -Sujetos: 104 consumidores de droga seropositivos (69 hombres, 35 mujeres; edades desde 15 a 32; 13 co-infectados con virus de la hepatitis) y 13 consumidores de droga con SIDA (7 hombres, 6 mujeres; edades entre 16 y 37; 12 co-infectados con virus de la hepatitis). -Resultados: las formas más frecuentes de lesiones de la mucosa oral en el grupo de pacientes infectados por el VIHcandidiasis (32.7%), lesiones herpéticas (15.4%), queilitis glandular (3.9%), estomatitis aftosa recidivante (2%). La linfadenopatía regional fue observada en el 31% de los casos. Las lesiones ulceronecrotizantes de la mucosa oral fueron vistas en la región sublingual y la lengua en el 11.5% de los pacientes y se manifestaron con dolor, disartria, disfagia y disgeusia. Estas lesiones fueron halladas en consumidores de droga que se inyectaban los opioides sublingualmente. Los pacientes con SIDA tenían candidiasis oral (84.6%), lesiones herpéticas (53.8%), estomatitis aftosa recidivante (15.4%) y queilitis glandular (7%). Todos los pacientes con SIDA tenían xerostomía severa, y el 15.4% tenían hinchazón unilateral o bilateral de las glándulas parótidas. Se halló gingivoestomatitis ulceronecrotizante generalizada en el 50% de los pacientes pero no se identificaron las lesiones ulceronecrotizantes sublinguales. -Conclusiones: 1. El espectro de las lesiones de la cavidad oral de pacientes VIH/SIDA en la región de Perm es bastante amplio. 2. La diseminación de las lesiones de la cavidad oral está aumentando en proporción con la progresión de la enfermedad. 3. El cuidado dental de los pacientes VIH/SIDA debería incluir exámenes orales periódicos para monitorizar la progresión de su enfermedad y para aliviar los síntomas de las enfermedades oportunistas y neoplásicas, para mejorar la calidad de vida de los pacientes infectados por el VIH.-Objective: to study the frequency and spectrum of oral manifestations of HIV-infected drug-users in the Perm region. Subjects: 104 seropositive HIV-infected drug-users (69 male, 35 female ; ages15 to 32 years; 13 co-infected with hepatitis viruses) and 13 AIDS-infected drug-users (7 male, 6 female ; ages16 to 37 years; 12 co-infected with hepatitis viruses). -Results: the most frequent forms of oral mucosal lesions in the HIV-infected group - candidiasis (32.7%), herpetic lesions (15.4%), cheilitis glandularis (3.9%), recurrent aphthous stomatitis (2%). Regional lymphadenopathy was observed in 31% cases. The ulceronecrotic oral mucosal lesions were seen in the sublingual region and tongue in 11.5% patients and manifested with pain, dysarthria, dysphagia, and dysgeusia. These lesions were found in drug-users who injected the opioids sublingually. AIDS patients had oral candidiasis (84.6%), herpetic lesions (53.8%), recurrent aphthous stomatitis (15.4%) and cheilitis glandularis (7%). All AIDS-patients had severe xerostomia, and 15.4% had unilateral or bilateral swelling of the parotid glands. Generalized ulceronecrotic gingivostomatitis was found in 50% of the patients but the sublingual ulceronecrotic lesions were not identified. -Conclusions: 1. The spectrum of oral cavity lesions of HIV/ AIDS patients in Perm region is widespread enough. 2. Dissemination of oral cavity lesions is increasing in proportion of disease progression. 3. Dental care of HIV/AIDS patients should include periodic oral examinations to monitor their disease progression and to alleviate symptoms of oral opportunic and neoplastic diseases, to improve the life-style of the patients infected with HIV

Reduced salivary flow and colonization by mutans streptococci in children with Down syndrome

OBJECTIVES: Although individuals with Down syndrome have considerable oral disease, the prevalence of dental caries in this group is low. The present study aimed to compare known risk factors for dental caries development in children with Down syndrome and a matched population (siblings). In both populations, the number of acidogenic microorganisms, such as mutans streptococci, lactobacilli and Candida species, and the paraffin-stimulated pH, flow rate and IgA concentration in whole saliva were evaluated and compared. METHOD: Saliva was collected, and the caries index was evaluated in 45 sibling pairs aged between 6 and 18 years old. The salivary IgA concentration was determined by immunoturbidimetry. Salivary mutans streptococci, lactobacilli and Candida species were quantified on mitis salivarius agar containing bacitracin and 20% sucrose, rogosa agar supplemented with glacial acetic acid and sabouraud agar supplemented with chloramphenicol, respectively. RESULTS: Down syndrome children had a higher caries-free rate (p<0.05) and lower salivary mutans streptococci counts (p<0.03) compared to their siblings. Similar numbers of lactobacilli and Candida species were found in both groups. Salivary flow rates were 36% lower in Down syndrome children compared to their siblings (p<0.05). The salivary pH did not differ between Down syndrome children and controls. The Down syndrome children had an IgA secretion rate 29% lower than that of their siblings, but this difference was not statistically significant. CONCLUSIONS: In conclusion, the lower number of mutans streptococci in the saliva may be one of the factors contributing to the lower caries rate observed in Down syndrome children, despite evidence of hyposalivation