Analysis of the antibiotic prophylaxis prescribed by Spanish oral surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infection

Antibiotic prophylaxis to prevent local infection in oral surgery: use or abuse?

Antibiotics have a well-documented efficacy in the treatment of established infections and as prophylactic agents in medically compromised patients. However, the systematic administration of antibiotics to prevent local infections in fit patients is much more controversial. The aim of this paper is to reflect on the justification for prophylactic usage of antibiotics to prevent wound infection and to reason out the most appropriate antibiotic guidelines taking into account available scientific data and studies by other authors. Numerous clinical trials question the efficacy of antibiotics in preventing wound infection. While some studies establish that antibiotics reduce the incidence of postoperative infections, others compare their efficacy to that of placebo. Thus, scientific literature suggests that every oral surgical intervention is not tributary of systematic antibiotic prophylaxis to prevent local infections. Intrinsic surgical risk factors and the patient"s individual circumstances must be taken into account. Even though the efficacy of other antibiotics cannot be ruled out due to our limited comprehension of the bacteriologic interrelations intervening in the pathogenesis of postextraction local infection, the amoxicillin-clavulanic acid combination theoretically covers the complete odontogenic bacterial spectrum in Spain. When the prophylactic use of antibiotics is indicated, this should be performed preoperatively, at high doses, and its extent should not exceed 24 hours. Special attention should be paid to antiinfectious local measures that can minimize infection risk during the wound"s healing period

Enrichment cultures should be performed in the detection of bacterial oral human pathogens in DUWLs

Water delivered by dental units during routine dental practice is densely contaminated by bacteria. The aim of this study was to determine actual isolation of the microorganisms sprayed from Dental Unit Water Lines (DUWLs) when enrichment cultures are performed and to compare frequencies with those obtained without enrichment cultures. Moreover, the antimicrobial susceptibilities of the microorganisms isolated were also studied. Water samples were collected from one hundred dental equipments in use at Dental Hospital of our University in order to evaluate the presence/absence of microorganisms and to perform their presumptive identification. Aliquots from all of the samples were inoculated in eight different media including both enrichment and selective media. Minimal inhibitory concentrations (MIC) were determined by the broth dilution method. The results herein reported demonstrate that most of the DUWLs were colonized by bacteria from human oral cavity; when enrichment procedures were applied the percentage of DUWLs with detectable human bacteria was one hundred percent. The results showed that in order to evaluate the actual risk of infections spread by DUWLs the inclusion of a step of pre-enrichment should be performed. The need for devices preventing bacterial contamination of DUWLs is a goal to be achieved in the near future that would contribute to maintain safety in dental medical assistance

Analysis of the antibiotic prophylaxis prescribed by Spanish oral surgeons

Aim: To identify prophylactic antibiotic prescription practices among Spanish dentists with preferential dedication to Oral Surgery in different types of tooth extraction surgeries. Method: Members of the Spanish Oral Surgery Society were surveyed on antibiotic prophylaxis use in 4 different tooth extraction modalities scaled according to their surgical invasiveness. Results: Sixty-nine of the 105 distributed questionnaires were returned completed. Thirteen percent of the surveyed surgeons would prescribe antibiotics to prevent postoperative wound infection when confronted with conventional tooth extraction lasting less than 5 minutes. In the case of surgery lasting more than 5 minutes, the percentage of participants that would prescribe antibiotics increased to 39%. When a mucoperiosteal flap was elevated or an ostectomy was performed, 87% and 100%, respectively, would prescribe antibiotic prophylaxis. Amoxicillin and its combination with clavulanic acid were the most commonly prescribed antibiotics. All participants would prescribe the antibiotic orally, starting after surgery and with a duration that ranged from 2-8 days. Conclusions: The results obtained suggest that antibiotic prophylaxis for preventing local odontogenic infection is not being correctly implemented in Spain. This can generate new bacterial resistances, facilitate adverse drug reactions and favor opportunistic infections. Better designed studies are needed in order to clarify the role of antibiotics in the prevention of postsurgical wound infection

Complications of guided surgery and immediate loading in oral implantology: a report of 12 cases

Objectives: The growing interest in minimally invasive surgery, together with the possibility of fitting prostheses with immediate function, have led to the development of software capable of planning and manufacturing a surgical guide and prosthesis that can be placed upon conclusion of the implant surgery step. The present study evaluates the surgical and prosthetic complications of implant treatment with the guided surgery technique, together with patient comfort during and after treatment. Patients and methods: A retrospective observational study was made of 19 patients with partially or totally edentulous upper and/or lower maxillae, involving the placement of a total of 122 implants. All cases were planned and operated upon with the guided surgery technique. Results: A total of 122 implants were placed in 14 males and 5 females. The intraoperative surgical complications comprised a lack of primary stability, while the postoperative complications consisted of infections and a lack of implant osteointegration. Ten implants failed. The prosthetic complications in turn comprised loosening of the provisional prosthesis screws, prosthesis tooth fracture, and a lack of passive fit of the immediate prosthesis. The degree of patient satisfaction was evaluated using a verbal scale. Conclusions: Implant restoration with the guided surgery technique and immediate functional loading is a predictable procedure, provided patient selection and the surgical technique are adequate, affording lesser postoperative morbidity and increased patient satisfaction thanks to the immediate restoration of esthetics and function

Structured and unstructured continuous models for Wolbachia infections

We introduce and investigate a series of models for an infection of a diplodiploid host species by the bacterial endosymbiont Wolbachia. The continuous models are characterized by partial vertical transmission, cytoplasmic incompatibility and fitness costs associated with the infection. A particular aspect of interest is competitions between mutually incompatible strains. We further introduce an age-structured model that takes into account different fertility and mortality rates at different stages of the life cycle of the individuals. With only a few parameters, the ordinary differential equation models exhibit already interesting dynamics and can be used to predict criteria under which a strain of bacteria is able to invade a population. Interestingly, but not surprisingly, the age-structured model shows significant differences concerning the existence and stability of equilibrium solutions compared to the unstructured model.

Recomanacions per defensar l’informe al judici oral

L'equip de la comunitat d'assessorament tècnic penal s'ha aplegat, en aquesta ocasió,per elaborar una guia de bones pràctiques en l’exercici de la tasca pericial en la situació de judici oral. És a dir, un manual que ajudi a identificar els elements que cal posar en joc per contestar la pregunta clau de tot peritatge: és creïble, el relat?, i que alhora doni pistes clares sobre com presentar el resultat d’aquesta feina.

The effects of teacher talk on students’ oral productions

The present study is a brief personal enquiry into the teaching and learning of EFL in the classroom with an orientation to action and personal professional development. It focuses on teacher talk, making special emphasis on questions, as well as on students’ resulting oral productions. The research contains samples of empirical data, which include their interpretations in the light of relevant research literature, and a more personal overall reflection of the teaching practice. Both the analysis and the reflections derive to a large extent from the self-observation paper 1 (SO1) and the Practicum portfolio (PP) developed within the TED Masters Degree practicum stages

Analyzing complexity in foreign language monologic oral production in a CLIL context

The study tested three analytic tools applied in SLA research (T-unit, AS-unit and Idea-unit) against FL learner monologic oral data. The objective was to analyse their effectiveness for the assessment of complexity of learners' academic production in English. The data were learners' individual productions gathered during the implementation of a CLIL teaching sequence on Natural Sciences in a Catalan state secondary school. The analysis showed that only AS-unit was easily applicable and highly effective in segmenting the data and taking complexity measures

Implementing CLIL in a primary school in Spain : the effects of CLIL on L2 English learners' oral production skills

This study presents the results of implementing a CLIL programme in a Catalan primary school three years after the onset of the implementation. The main objective of this investigation was to determine the effects of CLIL on students’ L2 English oral performance in terms of Complexity, Accuracy and Fluency (CAF). The results obtained suggest that CLIL learners outperform non-CLIL learners not only in fluency, but also in syntactic complexity. However, despite the encouraging results, the study concludes that further research which transcends the methodological limitations observed in the study is needed in order to confirm the results

Ciclofosfamida oral metronómica en combinación con prednisona tras la progresión a docetaxel en pacientes afectados de un cáncer de próstata metastásico resistente a la castración (CPRC).

Estudi retrospectiu que avalua eficàcia i tolerabilitat de ciclofosfamida oral metronòmica (COM) més prednisona en CPRC com a segona línia de tractament després de la progressió a docetaxel. Quinze pacients foren tractats. L'objectiu principal fou eficàcia del tractament. Els objectius secundaris eren toxicitat, període lliure de progressió (PLP) i supervivència global (SG). La resposta parcial per PSA es va evidenciar en 33.3%. La mitjana del PLP i SG van ser de 4.1 mesos i 7.2 mesos respectivament. La principal toxicitat va ser l'astènia. COM és poc tòxica i pot ser una alternativa en aquells malalts amb mal estat

Incidencia y gravedad de la enfermedad por citomegalovirus en pacientes trasplantados renales que han recibido tratamiento anticipado o profilaxis con valganciclovir oral

Antecedentes: La infección por CMV es la más frecuente que sufren los receptores de trasplante de órgano sólido (TOS) en los primeros meses del trasplante. Son abundantes las estrategias de prevención y tratamiento de la enfermedad por CMV que se han desarrollado. Métodos: El objetivo fue evaluar la incidencia y severidad de la enfermedad por CMV en 387 receptores de trasplante renal que recibieron tratamiento profiláctico (grupo de alto riesgo, n = 251) o realizaron seguimiento de PCR de CMV por ser grupo de bajo riesgo (n = 136) y recibieron tratamiento anticipado (n = 17) con valganciclovir oral (900 mg/día) cuando presentaron & 1000 copias/ml. Resultados: Presentaron enfermedad por CMV, 2 (11,76%) pacientes del grupo de riesgo estándar, descrita como enfermedad leve y 20 (7,96%) pacientes del grupo de alto riesgo, descrita como enfermedad leve en 15 casos y como enfermedad grave en 5 casos. Aquellos pacientes que desarrollaron la enfermedad, respondieron al tratamiento con ganciclovir endovenoso durante 14 días seguido de valganciclovir oral hasta completar tres meses. Conclusión: El tratamiento profiláctico con valganciclovir oral para la prevención de enfermedad o infección por CMV solamente es necesario en los receptores de TOS de alto riesgo.

Differential time to positivity of blood cultures: a valid method for diagnosing catheter-related bloodstream infections in the intensive care unit

iii. Catheter-related bloodstream infection (CR-BSI) diagnosis usually involves catheter withdrawal. An alternative method for CR-BSI diagnosis is the differential time to positivity (DTP) between peripheral and catheter hub blood cultures. This study aims to validate the DTP method in short-term catheters. The results show a low prevalence of CR-BSI in the sample (8.4%). The DTP method is a valid alternative for CR-BSI diagnosis in those cases with monomicrobial cultures (80% sensitivity, 99% specificity, 92% positive predictive value, and 98% negative predictive value) and a cut-off point of 17.7 hours for positivity of hub blood culture may assess in CR-BSI diagnosis.

Reduction in catheter-related bloodstream infections in critically ill patients through a multiple system intervention.

Els catéters venosos centrals són necessaris per al maneig del pacient crític però poden ser l´origen d´una bacteriemia. Aquest estudi prospectiu de cohort té com a objectiu determinar la utilitat de l´aplicació d´unes mesures bàsiques de prevenció per disminuir la incidència de bacteriemia associada a catéter. Els resultats de l´estudi confirmen que l´aplicació d´aquest sistema d´intervenció múltiple basat en l´evidencia redueix de forma significativa les bacteriemies associades a catéter a la nostra UCI.