Contribution of Probiotics Streptococcus salivarius Strains K12 and M18 to Oral Health in Humans: A Review

The overgrowth and disequilibrium of pathogenic microorganism species both native and non-native to the oral cavity can manifest into a variety of different oral diseases, pathologies, and afflictions in humans, including dental caries, gingivitis, pharyngitis, halitosis, and oral candidiasis. Two bacterial strains with clinically-significant probiotic applications in curtailing the pathogenic bacterial growth involved in these conditions are Streptococcus salivarius strain K12 and Streptococcus salivarius strain M18. To summarize the most up-to-date in vitro, in vivo, and clinical research findings, administration of these S. salivarius strains typically in the form of probiotic lozenges results in colonization, reduction in inflammatory measures, and marked alterations to physical structure & gene expression of the oral epithelial cells of the pharynx, tongue, and buccal membrane. While K12 and M18’s reduction of pharyngitis and halitosis has been largely attributed to bacteriocin production, the probiotic strains utilize different modes of action to reduce other oral pathologies. The prevention of dental caries, gingivitis and oral candidiasis appears to be ultimately influenced by K12 and M18’s production of dextranase & urease, reduction of inflammatory cytokines, and direct physical attachment to pathogens, respectively. In addition to conferring several oral health benefits, these S. salivarius strains have been proven extremely safe for human consumption in clinical trials and have the potential for universal application as an alternative treatment to antibiotics in the aforesaid oral pathologies

Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE):an international observational study

Background: Stroke disproportionately affects people in low-income and middle-income countries. Although improvements in stroke care and outcomes have been reported in high-income countries, little is known about practice and outcomes in low and middle-income countries. We aimed to compare patterns of care available and their association with patient outcomes across countries at different economic levels. Methods: We studied the patterns and effect of practice variations (ie, treatments used and access to services) among participants in the INTERSTROKE study, an international observational study that enrolled 13 447 stroke patients from 142 clinical sites in 32 countries between Jan 11, 2007, and Aug 8, 2015. We supplemented patient data with a questionnaire about health-care and stroke service facilities at all participating hospitals. Using univariate and multivariate regression analyses to account for patient casemix and service clustering, we estimated the association between services available, treatments given, and patient outcomes (death or dependency) at 1 month. Findings: We obtained full information for 12 342 (92%) of 13 447 INTERSTROKE patients, from 108 hospitals in 28 countries; 2576 from 38 hospitals in ten high-income countries and 9766 from 70 hospitals in 18 low and middle-income countries. Patients in low-income and middle-income countries more often had severe strokes, intracerebral haemorrhage, poorer access to services, and used fewer investigations and treatments (p<0·0001) than those in high-income countries, although only differences in patient characteristics explained the poorer clinical outcomes in low and middle-income countries. However across all countries, irrespective of economic level, access to a stroke unit was associated with improved use of investigations and treatments, access to other rehabilitation services, and improved survival without severe dependency (odds ratio [OR] 1·29; 95% CI 1·14–1·44; all p<0·0001), which was independent of patient casemix characteristics and other measures of care. Use of acute antiplatelet treatment was associated with improved survival (1·39; 1·12–1·72) irrespective of other patient and service characteristics. Interpretation: Evidence-based treatments, diagnostics, and stroke units were less commonly available or used in low and middle-income countries. Access to stroke units and appropriate use of antiplatelet treatment were associated with improved recovery. Improved care and facilities in low-income and middle-income countries are essential to improve outcomes