João Paulo Becker Lotufo

A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters

AIM The aim of this 12-month prospective study was to assess the adjunctive effect of smoking cessation in non-surgical periodontal therapy of subjects with severe chronic periodontitis. MATERIALS AND METHODS Of the 201 subjects enrolled from a smoking cessation clinic, 93 were eligible and received non-surgical periodontal treatment and concurrent smoking cessation treatment. Periodontal maintenance was performed every 3 months. Full-mouth periodontal examination in six sites per tooth was performed by a calibrated examiner, blinded to smoking status, at baseline, 3, 6 and 12 months after non-surgical periodontal treatment. Furthermore, expired air carbon monoxide concentration measurements and interviews based on a structured questionnaire were performed in order to collect demographic and smoking data. RESULTS Of the 93 eligible subjects, 52 remained in the study after 1 year. Of these, 17 quit smoking and 35 continued smoking or oscillated. After 1 year, only quitters presented significant clinical attachment gain (p=0.04). However, there were no differences between the groups regarding clinical attachment level, probing depth, bleeding on probing and plaque index after 1 year (p>0.05). CONCLUSION Smoking cessation promoted clinical attachment gain in chronic periodontitis subjects from a smoking cessation clinic after 1 year of follow-up.

Maternal smoking during pregnancy: Impact on otoacoustic emissions in neonates

OBJECTIVES To determine the effect of maternal smoking during pregnancy on transient evoked otoacoustic emissions levels in neonates. METHODS This was a cross-sectional study investigating neonates in the maternity ward of a university hospital in the city of São Paulo, Brazil. A total of 418 term neonates without prenatal or perinatal complications were evaluated. The neonates were divided into two groups: a study group, which comprised 98 neonates born to mothers who had smoked during pregnancy; and a control group, which comprised 320 neonates born to mothers who had not. In order to compare the two ears and the two groups in terms of the mean overall response and the mean transient evoked otoacoustic emissions in response to acoustic stimuli delivered at different frequencies, we used analysis of variance with repeated measures. RESULTS The mean overall response and the mean frequency-specific response levels were lower in the neonates in the study group (p<0.001). The mean difference between the groups was 2.47 dB sound pressure level (95% confidence interval: 1.47-3.48). CONCLUSIONS Maternal smoking during pregnancy had a negative effect on cochlear function, as determined by otoacoustic emissions testing. Therefore, pregnant women should be warned of this additional hazard of smoking. It is important that smoking control be viewed as a public health priority and that strategies for treating tobacco dependence be devised.

Dot-enzyme-linked immunosorbent assay (Dot-ELISA) for detection of pneumococcal polysaccharide antigens in pleural fluid effusion samples.: Comparison with bacterial culture, counterimmunoelectrophoresis and latex agglutination

Dot-ELISA para deteccao de antigenos polissacaridicos de pneumococos foi padronizado em vista da necessidade de se ter um diagnostico rapido e eficaz para pneumonia pneumococica aguda. Um total de 480 amostras de liquido pleural sendo 442 de criancas com diagnostico clinico e laboratorial de pneumonia bacteriana e 38 de pacientes com tuberculose, mais 20 amostras de soros sanguineos de criancas sadias foram avaliadas no Dot-ELISA. As amostras foram tratadas previamente a 90°C por 10 min com EDTA 0,1 M de pH 7,5 e aplicadas sobre membrana de nitrocelulose. Para a deteccao de antigeno pneumococico foi empregado omniserum pneumococico diluido a 1:200. Os resultados de Dot-ELISA avaliados em comparacao com os resultados de cultura bacteriana, contra-imunoeletroforese e latex-aglutinacao apresentaram indices de 0,940 para sensibilidade, 0,830 para especificidade e 0,760 para concordância. Omniserum pneumococico mostrou ser um otimo soro polivalente para a deteccao de antigenos pneumococicos em Dot-ELISA e, essa tecnica provou ser uma alternativa pratica e eficaz para o diagnostico de pneumonias pneumococicas.A dot-enzyme-linked immunosorbent assay (Dot-ELISA) for pneumococcal antigen detection was standardized in view of the need for a rapid and accurate immunodiagnosis of acute pneumococcal pneumonia. A total of 442 pleural fluid effusion samples (PFES) from children with clinical and laboratory diagnoses of acute bacterial pneumonia, plus 38 control PFES from tuberculosis patients and 20 negative control serum samples from healthy children were evaluated by Dot-ELISA. The samples were previously treated with 0.1M EDTA pH 7.5 at 90 degrees C for 10 min and dotted on nitrocellulose membrane. Pneumococcal omniserum diluted at 1:200 was employed in this assay for antigen detection. When compared with standard bacterial culture, counterimmunoelectrophoresis and latex agglutination techniques, the Dot-ELISA results showed relative indices of 0.940 to sensitivity, 0.830 to specificity and 0.760 to agreement. Pneumococcal omniserum proved to be an optimal polyvalent antiserum for the detection of pneumococcal antigen by Dot-ELISA. Dot-ELISA proved to be a practical alternative technique for the diagnosis of pneumococcal pneumonia.

Impacto do uso da prova rápida para estreptococo beta-hemolítico do grupo A no diagnóstico e tratamento da faringotonsilite aguda em pronto-socorro de Pediatria

OBJETIVO: Evaluar el impacto de la realizacion de rutina de la prueba rapida para investigacion de estreptococos del grupo A en el diagnostico y tratamiento de la faringotonsilitis aguda en ninos. METODOS: Estudio prospectivo y observacional que conto con el uso de protocolo de investigacion establecido en la Unidad de Emergencia del Hospital Universitario de la USP para la atencion a ninos y adolescentes con faringotonsilitis aguda. RESULTADOS: Con base en la evaluacion critica, de los 650 pacientes estudiados, antimicrobianos serian prescritos a 389 individuos (59,8%) y, con el uso de la investigacion de estreptococos del grupo A se los prescribieron a 286 pacientes (44,0%). De los 261 ninos que no recibirian antibioticos por el cuadro clinico, 111 (42,5%) tuvieron investigacion de estreptococos del grupo A positiva. El diagnostico basado en el cuadro clinico presento sensibilidad del 61,1%, especificidad del 47,7%, valor predictivo positivo del 44,9% y valor predictivo negativo del 57,5%, CONCLUSIONES: En este estudio, el diagnostico clinico de la faringotonsilitis estreptococica mostro baja sensibilidad y especificidad. El uso de rutina de la prueba rapida para investigacion de estreptococos permitio la reduccion del uso de antibioticos y la identificacion de un grupo de riesgo para las complicaciones de la infeccion estreptococica, pues el 42,5% de los pacientes con prueba rapida positiva no recibirian antibioticos si se llevara en consideracion solamente el diagnostico clinico.OBJECTIVE To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. METHODS This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. CONCLUSIONS The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

Impact of the rapid antigen detection test in diagnosis and treatment of acute pharyngotonsillitis in a pediatric emergency room.

OBJETIVO: Evaluar el impacto de la realizacion de rutina de la prueba rapida para investigacion de estreptococos del grupo A en el diagnostico y tratamiento de la faringotonsilitis aguda en ninos. METODOS: Estudio prospectivo y observacional que conto con el uso de protocolo de investigacion establecido en la Unidad de Emergencia del Hospital Universitario de la USP para la atencion a ninos y adolescentes con faringotonsilitis aguda. RESULTADOS: Con base en la evaluacion critica, de los 650 pacientes estudiados, antimicrobianos serian prescritos a 389 individuos (59,8%) y, con el uso de la investigacion de estreptococos del grupo A se los prescribieron a 286 pacientes (44,0%). De los 261 ninos que no recibirian antibioticos por el cuadro clinico, 111 (42,5%) tuvieron investigacion de estreptococos del grupo A positiva. El diagnostico basado en el cuadro clinico presento sensibilidad del 61,1%, especificidad del 47,7%, valor predictivo positivo del 44,9% y valor predictivo negativo del 57,5%, CONCLUSIONES: En este estudio, el diagnostico clinico de la faringotonsilitis estreptococica mostro baja sensibilidad y especificidad. El uso de rutina de la prueba rapida para investigacion de estreptococos permitio la reduccion del uso de antibioticos y la identificacion de un grupo de riesgo para las complicaciones de la infeccion estreptococica, pues el 42,5% de los pacientes con prueba rapida positiva no recibirian antibioticos si se llevara en consideracion solamente el diagnostico clinico.OBJECTIVE To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. METHODS This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. CONCLUSIONS The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

Virological Response to Standard- and Double-Dose Oseltamivir Treatment in Patients With Pandemic (H1N1) 2009 Influenza: A Prospective Randomized Trial

BackgroundIn the early stages of the 2009 influenza pandemic, little was known about the pandemic (H1N1) 2009 virus or its response to neuraminidase inhibitor therapy. MethodsBetween April 2009 and August 2010, we conducted an open-label study of the response to oseltamivir therapy when administered at the recommended dose or at double the recommended dose twice daily for 5 days. ResultsThirty-eight patients aged 5 years or older with laboratory-confirmed pandemic (H1N1) 2009 influenza were randomly assigned to treatment. After 5 days, substantial reductions in viral load and clinical signs and symptoms of influenza were observed in the standard- and double-dose groups relative to baseline values. The double-dose regimen did not provide additional benefit over the standard-dose regimen. No resistant viruses were detected. Both regimens were well tolerated, and no serious adverse events were reported. ConclusionsStandard- and double-dose oseltamivir regimens were well tolerated in this patient group.

Predictors of smoking cessation in smokers with chronic periodontitis: a 24-month study

The purpose of this 24-month study was to identify predictors of smoking cessation in a cohort of smokers with chronic periodontitis, attending a multidisciplinary smoking cessation program. Of the 286 subjects screened, 116 were included and received non-surgical periodontal treatment and smoking cessation therapy, which consisted of lectures, cognitive behavioral therapy, and pharmacotherapy, according to their individual needs. During initial periodontal treatment, dentists actively motivated the study subjects to stop smoking, using motivational interviewing techniques. Further smoking cessation counseling and support were also provided by the dentists, during periodontal maintenance sessions at 3, 6, 12 and 24 months of follow-up. Smoking status was assessed by means of a structured questionnaire, and was validated by exhaled carbon monoxide (CO) measurements. The Fagerström Test for Cigarette Dependence was used to assess smoking dependence. Of the 61 individuals that remained up to the 24-month examination, 31, 21 and 18 declared that they were not smoking at 3, 12 and 24 months, respectively. Smoking cessation after 24 months was associated with the male gender (OR = 3.77, 95%CI = 1.16-12.30), baseline CO levels less than 10ppm (OR = 5.81, 95%CI 1.76-19.23), not living or working with another smoker (OR = 7.38, 95%CI 1.76-30.98) and a lower mean Fagerström test score (OR = 5.63, 95%CI 1.55-20.43). We concluded that smoking cessation was associated with demographic, smoking history and cigarette dependence variables.

Impacto del uso de la prueba rápida para estreptococos beta-hemolíticos del grupo A en el diagnóstico y tratamiento de la faringotonsilitis en emergencia de Pediatría

OBJETIVO: Evaluar el impacto de la realizacion de rutina de la prueba rapida para investigacion de estreptococos del grupo A en el diagnostico y tratamiento de la faringotonsilitis aguda en ninos. METODOS: Estudio prospectivo y observacional que conto con el uso de protocolo de investigacion establecido en la Unidad de Emergencia del Hospital Universitario de la USP para la atencion a ninos y adolescentes con faringotonsilitis aguda. RESULTADOS: Con base en la evaluacion critica, de los 650 pacientes estudiados, antimicrobianos serian prescritos a 389 individuos (59,8%) y, con el uso de la investigacion de estreptococos del grupo A se los prescribieron a 286 pacientes (44,0%). De los 261 ninos que no recibirian antibioticos por el cuadro clinico, 111 (42,5%) tuvieron investigacion de estreptococos del grupo A positiva. El diagnostico basado en el cuadro clinico presento sensibilidad del 61,1%, especificidad del 47,7%, valor predictivo positivo del 44,9% y valor predictivo negativo del 57,5%, CONCLUSIONES: En este estudio, el diagnostico clinico de la faringotonsilitis estreptococica mostro baja sensibilidad y especificidad. El uso de rutina de la prueba rapida para investigacion de estreptococos permitio la reduccion del uso de antibioticos y la identificacion de un grupo de riesgo para las complicaciones de la infeccion estreptococica, pues el 42,5% de los pacientes con prueba rapida positiva no recibirian antibioticos si se llevara en consideracion solamente el diagnostico clinico.OBJECTIVE To evaluate the impact of the routine use of rapid antigen detection test in the diagnosis and treatment of acute pharyngotonsillitis in children. METHODS This is a prospective and observational study, with a protocol compliance design established at the Emergency Unit of the University Hospital of Universidade de São Paulo for the care of children and adolescents diagnosed with acute pharyngitis. RESULTS 650 children and adolescents were enrolled. Based on clinical findings, antibiotics would be prescribed for 389 patients (59.8%); using the rapid antigen detection test, they were prescribed for 286 patients (44.0%). Among the 261 children who would not have received antibiotics based on the clinical evaluation, 111 (42.5%) had positive rapid antigen detection test. The diagnosis based only on clinical evaluation showed 61.1% sensitivity, 47.7% specificity, 44.9% positive predictive value, and 57.5% negative predictive value. CONCLUSIONS The clinical diagnosis of streptococcal pharyngotonsillitis had low sensitivity and specificity. The routine use of rapid antigen detection test led to the reduction of antibiotic use and the identification of a risk group for complications of streptococcal infection, since 42.5% positive rapid antigen detection test patients would not have received antibiotics based only on clinical diagnosis.

Impact of the use of rapid antigen detection test in the diagnosis and treatment of acute pharyngitis in pediatric emergency room

Methods: Retrospective analysis of 11 years bronchoscopy data in the Pediatric Pulmonologic Institute of Hadassah University Hospital and prospective telephonic follow up. Results: Out of 3700 bronchoscopies (mean age 2.5 years), 2268 (61%) were performed due to suspected airway obstruction. Tracheo or Broncho malacia was found in 827 children, of them, 102 children performed chest CT angiography, of them, 47 performed also echocardiography. Telephone follow up was performed to 58 children (mean 4.5 years after bronchoscopy). Thirteen children underwent operation due to double aortic arch (n =10), aberrant innominate artery (n =1), right aortic arch with fibrotic band (n =1), severe right primary bronchomalacia (n = 1). All these children had moderate to severe airway obstruction (>50%) by bronchoscopy and CT. Echocardiography diagnosed 9 out of 10 vascular rings. Conclusions: Echocardiography should be performed in every pulsate tracheo-bronchomalacia. Mild (<50%) airway obstruction can be followed up. In moderate to severe airway obstruction with continues respiratory symptoms, MRI or CT focused to the level of the pathology should be performed. Using this workup diagnosis the use of CT will be decreased in 40% at least.

Evaluation of the therapeutic efficacy of dexamethasone in meningococcal meningitis

OBJECTIVE: To evaluate the efficacy of dexamethasone as an auxiliary therapeutic tool to the antibiotics in hospitalized children with meningococcal meningitis. METHODS: A retrospective clinical comparative study was undertaken with children from a pediatric ward affected by laboratory proved meningococcal meningitis at a university hospital. Cases of children in state of shock at admission or deceased in the first 24 hours were excluded. During the period from 1987 to 1989 33 children were treated only with antibiotics (group A), while from 1990 to 1993 other 66 children received additionally dexamethasone (12mg/m2/24h) by intravenous route during four days beginning at the admission to the hospital (group B). The two groups were evaluated at baseline through prognostic scores and analysis of their clinical and laboratorial characteristics obtained from data recorded at the admission. The parameters to evaluate dexamethasone efficacy were the comparative number of neurologic and systemic complications detected at the hospital, and the liquoric profile (leukocyte count, glucose and protein content) verified between day 9 and day 11 of hospitalization. RESULTS: The profile of the two groups (A and B) were homogeneously evaluated by the illness severity scores and their clinical and laboratorial characteristics. Nine complications were recognized in group A (27.2%) and 21 (31.8%) among those of group B, difference not significant. Likewise, there were not observed liquoric differences between the two groups related to the chimiocytologic pattern. CONCLUSIONS: No effect of dexamethasone therapy to prevent neurologic and systemic meningococcal meningitis complications was observed during hospitalization. Similarly no favorable effect in relation to the liquoric pattern verified between day 9 and day 11 of hospitalization was recognized.