Caries-related factors and bacterial composition of supragingival plaques in caries free and caries active Algerian adults

Objective: To compare oral hygiene practices, education and social background, food intake and oral malodor of Algerian adults suffering from dental caries with normal controls, and to determine and compare the bacterial composition of the supragingival plaques from the above-mentioned groups.Methods: Participants completed a questionnaire and were clinically examined for dental caries using decayed, missing and filled teeth index according to the criteria laid down by the World Health Organization. Supragingival plaque samples were collected from 50 caries-free adults(CF) and 50 caries-active adults(CA). Standard procedures of culture and identification of aerobic and anaerobic bacteria were used. Data were analyzed using Chi-square test.Results: A total of 117 bacterial strains were isolated from supragingival plaques in CF group subjects, 76(64.96%) of them belonged to 9 aerobic genera, and 41(35.04%) to 9anaerobic genera(P < 0.05). While in the second group, 199 strains were isolated, 119(59.80%) of the strains belonged to 10 aerobic genera and 80(40.20%) to 10 anaerobic bacteria(P < 0.05). Streptococcus mutans, Enterococcus faecium, Aerococcus viridans,Actinomyces meyeri, Lactobacillus acidophilus and Eubacterium limosum showed a significantly higher prevalence in the CA group(P < 0.05). The findings revealed that CA group had a high sugar intake(80%). A significantly higher frequency of tooth brushing(P < 0.000) and a significantly less self-reported oral malodor(P < 0.000) and tooth pain(P < 0.000) were found in CF group, while there was no association of socioeconomic levels and intake of meal snacks with dental caries.Conclusions: This study confirms the association of some aciduric bacteria with caries formation, and a direct association of sugar intake and cultural level with dental caries.Furthermore, oral hygiene practices minimize the prevalence of tooth decay.

Severe asthma exacerbation:Changes in patient characteristics,management,and outcomes from 1997 to 2016 in 40 ICUs in the greater Paris area

Background Despite advances in asthma treatments,severe asthma exacerbation(SAE)remains a life-threatening condition in adults,and there is a lack of data derived from adult patients admitted to intensive care units(ICUs)for SAE.The current study investigated changes in adult patient characteristics,management,and outcomes of SAE over a 20-year period in 40 ICUs in the greater Paris area.Methods In this retrospective observational study,admissions to 40 ICUs in the greater Paris area for SAE from January 1,1997,to December 31,2016 were analyzed.The primary outcome was the proportion of ICU admissions for SAE during 5-year periods.Secondary outcomes were ICU and hospital mortality,and the use of mechanical ventilation and catecholamine.Multivariate analysis was performed to assess factors associated with ICU mortality.Results A total of 7049 admissions for SAE were recorded.For each 5-year period,the proportion decreased over time,with SAE accounting for 2.84%of total ICU admissions(n=2841)between 1997 and 2001,1.76%(n=1717)between 2002 and 2006,1.05%(n=965)between 2007 and 2011,and 1.05%(n=1526)between 2012 and 2016.The median age was 46 years(interquartile range[IQR]:32–59 years),55.41%were female,the median Simplified Acute Physiology Score II was 20(IQR:13–28),and 19.76%had mechanical ventilation.The use of mechanical ventilation remained infrequent throughout the 20-year period,whereas the use of catecholamine decreased.ICU and hospital mortality rates decreased.Factors associated with ICU mortality were renal replacement therapy,catecholamine,cardiac arrest,pneumothorax,acute respiratory distress syndrome,sepsis,and invasive mechanical ventilation(IMV).Non-survivors were older,had more severe symptoms,and were more likely to have received IMV.Conclusion ICU admission for SAE remains uncommon,and the proportion of cases decreased over time.Despite a slight increase in symptom severity during a 20-year period,ICU and hospital mortality decreased.Patients requiring IMV had a higher mortality rate.

Septic cardiomyopathy: Diagnosis and management

There is an extensive body of literature focused on sepsis-induced myocardial dysfunction,but results are con-flicting and no objective definition of septic cardiomyopathy(SCM)has been established.SCM may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular(LV)dysfunction and/or right ventricular dysfunction.Physicians should consider this diagnosis in patients with sepsis-associated organ dysfunction,and particularly in cases of septic shock that require vasopres-sors.Echocardiography is currently the gold standard for diagnosis of SCM.Left ventricular ejection fraction is the most common parameter used to describe LV function in the literature,but its dependence on loading condi-tions,particularly afterload,limits its use as a measure of intrinsic myocardial contractility.Therefore,repeated echocardiography evaluation is mandatory.Evaluation of global longitudinal strain(GLS)may be more sensi-tive and specific for SCM than LV ejection fraction(LVEF).Standard management includes etiological treatment,adapted fluid resuscitation,use of vasopressors,and monitoring.Use of inotropes remains uncertain,and heart rate control could be an option in some patients.