Dietary vitamin D and cancers of the oral cavity and esophagus.

BACKGROUND: Data on the association between vitamin D and upper digestive tract neoplasms are limited. METHODS: In two case-control studies in Italy, we examined the relation between dietary vitamin D intake and squamous cell carcinoma of the esophagus (SCCE; 304 cases) and oral/pharyngeal cancer (804 cases). Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by multiple logistic regression. RESULTS: Adjusted ORs for SCCE and oral/pharyngeal cancer were 0.58 (95% CI 0.39-0.86) and 0.76 (95% CI 0.60-0.94), respectively, for the highest tertile of vitamin D intake. Using a reference group of those in the highest tertile of vitamin D who were never/former smokers, ORs were 8.7 (95% CI 4.1-18.7) for SCCE and 10.4 (95% CI 6.9-15.5) for oral/pharyngeal cancer among heavy smokers in the lowest vitamin D tertile; similarly, compared with those in the highest tertile of vitamin D who drank <3 alcoholic drinks/day, corresponding ORs were 41.9 (95% CI 13.7-128.6) for SCCE and 8.5 (95% CI 5.7-12.5) for oral/pharyngeal cancer, among heavy alcohol drinkers in the lowest vitamin D tertile. CONCLUSION: We observed inverse associations between dietary vitamin D intake and risk of SCCE and, perhaps, oral/pharyngeal cancer, which were most pronounced among heavy current smokers and heavy consumers of alcohol.

Thermogenic response to an oral glucose load in man: comparison between young and elderly subjects.

To investigate the effect of age and change in body composition on the increase in energy expenditure consecutive to the ingestion of a 75-g glucose load, respiratory exchange measurements were performed on 24 subjects, 12 elderly (mean +/- SEM, 73 +/- 1 yr) and 12 young (25 +/- 1 yr). The body weight was comparable, 62 +/- 2 kg in the elderly group vs 61 +/- 3 in the young, but the body fat content of the elderly group was significantly greater than that of the young (29 +/- 2% vs 19 +/- 2%, p less than 0.001). The elderly group presented a slight glucose intolerance according to the World Health Organization (WHO) criteria, with a 120-min plasma glucose of 149 +/- 9 mg/dl (p less than 0.005 vs young). The postabsorptive resting energy expenditure (REE) was 0.83 +/- 0.03 kcal/min in the elderly group vs 0.98 +/- 0.04 in the young (p less than 0.02); this decrease of 15% was mainly related to the decrease in fat free mass (FFM) in the elderly group, which averaged 14%. The difference was not significant when REE was expressed per kg FFM. The glucose-induced thermogenesis (GIT) expressed as percent of energy content of the load was 6.2 +/- 0.6% in the elderly group and 8.9 +/- 0.9% in the young (p less than 0.05). It is concluded that the glucose-induced thermogenesis is decreased in elderly subjects. However, when expressed per kg FFM, the increment in energy expenditure (EE), in response to the glucose load, is not different in elderly subjects, suggesting that the decrease of thermogenesis may be attributed to the age-related decrease in FFM.

Oral Correction in Foreign Language Classrooms

This paper analyses the correction of errors and mistakes made by students in the Foreign Language Teaching classroom. Its goal is to point out typical correction behaviors in Cape Verde in Language Teaching classrooms and raise teachers’ consciousness concerning better correction practice.

A importância da educação para a saúde oral nos adolescentes nas escolas secundárias do conselho de São Vicente

A cárie dentária afecta a população mundial e é o responsável pela dor e perda dos dentes. Prevalece nas crianças que frequentam o pré-escolar, o ensino básico e nos adolescentes do ensino secundário e tem implicações no bem-estar individual e social dos afectados. A pesquisa que desenvolvemos cuja pergunta de partida é: como o enfermeiro pode intervir no sentido de melhorar a saúde oral dos adolescentes? E o título A importância da Educação para a Saúde Oral nos adolescentes nas escolas secundárias do concelho de São Vicente, é de carácter quantitativo, uma vez que recolhemos uma amostra constituída por 80 alunos do 7ºano e 80 alunos do 11ºano das escolas secundárias da ilha de São Vicente, através de um inquérito por questionário fechado, tendo em conta três dimensões: a caracterização do aluno; as questões relacionadas com os hábitos de higiene oral e com os hábitos alimentares, e depois foram realizadas sessões de Educação para a Saúde (EpS), para proporcionar conhecimentos sobre a saúde oral, sensibilizar os alunos sobre os problemas orais e apostar na prevenção. Posteriormente examinamos os dados numericamente, através das estatísticas. Paralelamente o processo de recolha e tratamento de dados remete para um estudo de carácter qualitativo, por termos feito observações dentro e fora das escolas, conversado com os membros do corpo directivo e por causa de toda a reestruturação que foi sendo feita enquanto desenvolvíamos esta pesquisa, Relativamente à análise dos dados, a maioria dos alunos inquiridos, revelaram ter comportamentos e hábitos de saúde oral adequados. Uma minoria, tanto no 7º como no 11º anos afirmou não ter cárie dentária. Porém, a maioria já teve ou tem sangramento durante a escovagem dos dentes e também dores nos dentes. A percentagem desses sintomas não corresponde à percentagem da cárie dentária, o que denuncia discordâncias entre algumas respostas. Neste sentido, alertamos que este indicador deve ser tido em conta em futuros trabalhos de intervenção a serem realizados na comunidade estudantil para que possa ser feita uma observação da cavidade oral e assim clarificá-lo.

Os manuais de língua portuguesa e o desenvolvimento da expressão oral no ensino secundário de Cabo Verde

Na elaboração do presente trabalho, que tem como tema “Os manuais de língua portuguesa e o desenvolvimento da expressão oral no ensino secundário de Cabo Verde”, procurou-se investigar, a partir da perspectiva dos manuais de Língua Portuguesa, até que ponto os mesmos podem servir ou não para o desenvolvimento da competência comunicativa dos alunos do ensino secundário, na modalidade de expressão oral. Para isso foi adoptada uma metodologia situada no campo da investigação educacional, sem pôr de lado os métodos da pesquisa qualitativa e quantitativa, o que permitiu abordar as questões relacionadas com as constantes situações de insucesso na aprendizagem da Língua Portuguesa, cujas causas têm sido atribuídas, quase sempre, aos factores como as metodológicas, aos problemas linguísticos, decorrentes da forte presença da língua materna no quotidiano dos aprendentes e ao uso de materiais desajustados da realidade nacional. Assim, para o cumprimento dos objectivos propostos, foi possível trabalhar sobre dois corpora; por um lado analisaram-se os manuais do ensino secundário, por outro, foi examinado o inquérito aplicado tanto aos professores como aos alunos, e cujo tratamento dos dados permitiu confirmar a aceitação entusiástica dos manuais escolares no contexto pedagógico, apesar da descrença na potencialidade dos exercícios propostos em desenvolver a capacidade de expressão oral dos alunos. Outro aspecto digno de registo foi o desejo manifestado pelos informantes em ter outros materiais capazes de melhorar o ensino do Português como língua segunda. Em termos do ensino da citada disciplina, foram apresentadas algumas sugestões para que a sua melhoria reverta a favor do sucesso de aprendizagem de todos os alunos

A single high dose of oral Vitamin D3 is not enough to correct insufficiency and deficiency in a rheumatologic population

Introduction: Vitamin D plays a major role in bone metabolism and neuromuscular function. Supplementation with vitamin D is effective to reduce the risk of fall and of fracture. However adherence to oral daily vitamin D supplementation is low. Screening and correcting vitamin D insufficiency in a general rheumatologic population could improve both morbidity and quality of life in these patients with chronic painful disorders and at high risk of osteoporosis. After determining the prevalence of vitamin D deficiency in this population, we evaluated if supplementation with a single high dose of oral 25-OH vitamin D3 was sufficient to correct this abnormality. Methods: During one month (November 2009), levels of 25-OH vitamin D were systematically determined in our rheumatology outpatient clinic and classified into three groups: vitamin D deficiency (<10 µg/l), vitamin D insufficiency (10 to 30µg/l) or normal vitamin D (>30 µg/l). Patients with insufficiency or deficiency received respectively a single high dose of 300'000 IU or 600'000 IU oral vitamin D3. In addition, all patients with osteoporosis were prescribed daily supplement of calcium (1g) and vitamin D (800 IU). 25-OH vitamin D levels were reevaluated after 3 months. Results: Vitamin D levels were initially determined in 292 patients (mean age 53, 211 women, 87% Caucasian). 77% had inflammatory rheumatologic disease (IRD), 20% osteoporosis (OP) and 12% degenerative disease (DD). Vitamin D deficiency was present in 20 (6.8%), while 225 (77.1%) had insufficiency. Of the 245 patients with levels <30µg/l, a new determination of vitamin D level was available in 173 (71%) at 3 months (table 1). Conclusion: Vitamin D insufficiency is highly prevalent in our rheumatologic population (84%), and is not adequately corrected by a single high dose of oral vitamin D3 in more than half of the patients with IRD and DD. In patients with OP, despite association of a single high dose with daily oral vitamin D supplementation, 40% of patients are still deficient when reevaluated at 3 months.

Antibiothérapie empirique lors de neutropénie fébrile [Empirical antibiotic therapy for febrile neutropenia]

Immediate broad-spectrum empirical antibacterial therapy is the key of management in febrile neutropenic patients. These patients can be stratified according to the risk of complications with the clinical MASCC score. Patients at low risk of complications can be efficaciously treated with oral antibiotics (e.g. fluoroquinolone and beta-lactam), provided that compliance and drug absorption are adequate. Early discharge is possible if clinical, logistic, and social criteria are fulfilled. Intravenous antibiotic therapy with broad-spectrum beta-lactam antibiotics in the hospital remains the standard in high-risk patients. The empirical addition of an aminoglycoside and/or a glycopeptide is recommended if the local incidence of infections due to beta-lactam resistant pathogens is high or in critically ill septic patients.

Allergen-specific antibody and cytokine responses, mast cell reactivity and intestinal permeability upon oral challenge of sensitized and tolerized mice.

BACKGROUND: Food allergy has reached an epidemic level in westernized countries and although central mechanisms have been described, the variability associated with genetic diversity underscores the still unresolved complexity of these disorders. OBJECTIVE: To develop models of food allergy and oral tolerance, both strictly induced by the intestinal route, and to compare antigen-specific responses. METHODS: BALB/c mice were mucosally sensitized to ovalbumin (OVA) in the presence of the mucosal adjuvant cholera toxin, or tolerized by intra-gastric administrations of OVA alone. Antibody titres and cytokines were determined by ELISA, and allergic status was determined through several physiologic parameters including decline in temperature, diarrhoea, mast cell degranulation and intestinal permeability. RESULTS: OVA-specific antibodies (IgE, IgGs and IgA in serum and feces) were produced in sensitized mice exclusively. Upon intra-gastric challenge with OVA, sensitized mice developed anaphylactic reactions associated with a decline of temperature, diarrhoea, degranulation of mast cells, which were only moderately recruited in the small intestine, and increased intestinal permeability. Cytokines produced by immune cells from sensitized mice included T-helper type 2 cytokines (IL-5, IL-13), but also IL-10, IFN-gamma and IL-17. In contrast, all markers of allergy were totally absent in tolerized animals, and yet the latter were protected from subsequent sensitization, demonstrating that oral tolerance took place efficiently. CONCLUSION: This work allows for the first time an appropriate comparison between sensitized and tolerized BALB/c mice towards OVA. It highlights important differences from other models of allergy, and thus questions some of the generally accepted notions of allergic reactions, such as the protective role of IFN-gamma, the importance of antigen-specific secretory IgA and the role of mucosal mast cells in intestinal anaphylaxis. In addition, it suggests that IL-17 might be an effector cytokine in food allergy. Finally, it demonstrates that intestinal permeability towards the allergen is increased during challenge.

Inflammasome Activation in Response to Eukaryotic Pathogens

Inflammasomes are multi-protein complexes that serve as platforms for caspase-1 activation and subsequent proteolytic maturation of interkeukin 1ß (IL-1ß) within innate immune cells. The Nlrp3 inflammasome is the most fully characterised. It is activated by various endogenous danger signals such as environmental irritants, signals of tissue damage and pathogens. The broad spectrum of activators is reflected at the physiological level in its implication in normal and dysregulated immune responses, including various autoinflammatory diseases and the defence agaisnt numerous pathogens. Here, we summarise the present data on the activation of the Nlrp3 inflammasome by eukaryotic pathogens. Recent genetic studies using mice deficient in inflammasome components demonstrate the involvement of the inflammasome in the outcome of infection with the fungus Candida albicans, the helminth Schistosoma mansoni, as well as the malarial parasite Plasmodium berghei. Altered immune responses were respectively linked to the ability of live fungi, schistosomal egg antigen (SEA) or malarial hemozoin to activate the inflammasome and induce secretion of mature IL-1ß. The initial findings suggest that inflammasome activation may serve as a common and potentially druggable pathway in the defence agaisnt eukaryotic pathogens

Enterococcal endocarditis in the beginning of the 21st century: analysis from the International Collaboration on Endocarditis-Prospective Cohort Study.

Enterococci are reportedly the third most common group of endocarditis-causing pathogens but data on enterococcal infective endocarditis (IE) are limited. The aim of this study was to analyse the characteristics and prognostic factors of enterococcal IE within the International Collaboration on Endocarditis. In this multicentre, prospective observational cohort study of 4974 adults with definite IE recorded from June 2000 to September 2006, 500 patients had enterococcal IE. Their characteristics were described and compared with those of oral and group D streptococcal IE. Prognostic factors for enterococcal IE were analysed using multivariable Cox regression models. The patients' mean age was 65 years and 361/500 were male. Twenty-three per cent (117/500) of cases were healthcare related. Enterococcal IE were more frequent than oral and group D streptococcal IE in North America. The 1-year mortality rate was 28.9% (144/500). E. faecalis accounted for 90% (453/500) of enterococcal IE. Resistance to vancomycin was observed in 12 strains, eight of which were observed in North America, where they accounted for 10% (8/79) of enterococcal strains, and was more frequent in E. faecium than in E. faecalis (3/16 vs. 7/364 , p 0.01). Variables significantly associated with 1-year mortality were heart failure (HR 2.4, 95% CI 1.7--3.5, p <0.0001), stroke (HR 1.9, 95% CI 1.3--2.8, p 0.001) and age (HR 1.02 per 1-year increment, 95% CI 1.01--1.04, p 0.002). Surgery was not associated with better outcome. Enterococci are an important cause of IE, with a high mortality rate. Healthcare association and vancomycin resistance are common in particular in North America.

Paediatric oral peanut challenges: a comparison of practice in London and Western Switzerland.

BACKGROUND: There are guidelines on how to develop a food challenge protocol, but at present there is no gold standard guidance on method, and separate units produce differing protocols. METHODS: We performed a retrospective analysis of 200 patients' data from the paediatric allergy units in Lausanne and Geneva, Western Switzerland, and St Thomas' Hospital (STH), UK. RESULTS: St Thomas' Hospital has a younger cohort with a lower overall mean spIgE (2.36 kU/l vs 8.00 kU/l, P = 0.004). The target peanut protein volumes differed: Switzerland 4.4 g vs STH 8.4 g. Despite this, the dose actually achieved in positive challenges was not significantly different (2.33 g vs 1.49 g, P = 0.16). 26% of challenges reacted at 4 g or more of peanut protein. CONCLUSIONS: The differences in results highlight how the variation in reasoning behind food challenge alters the outcome. Standardization of food challenges would allow easy comparison between hospitals and geographical areas for research purposes.

The development of a stable oral solution of captopril for paediatric patients

Study objectives: Many major drugs are not available in paediatric form. The aim of this study was to develop a stable liquid solution of captopril for oral paediatric use allowing individualised dosage and easy administration to newborn and young patients. Methods: A specific HPLC-UV method was developed. In a pilot study, a number of formulations described in the literature as affording one-month stability were examined. In the proper long-term study, the formulation that gave the best results was then prepared in large batches and its stability monitored for two years at 5°C and room temperature, and for one year at 40°C. Results: Most formulations described in the literature were found wanting in our pilot study. A simple solution of the drug (1 mg/mL) in purified water (European Pharmacopeia) containing 0.1% disodium edetate (EDTA-Na) as preservative proved chemically and microbiologically stable at 5°C and room temperature for two years. Conclusion: The proposed in-house formulation fulfils stringent criteria of purity and stability and is fully acceptable for oral administration to newborn and young patients.