Hypertension is a chronic illness affecting more than a billion people worldwide. The high prevalence of the disease among the American population is concerning and must be considered when treating dental patients. Its lack of symptoms until more serious problems occur makes the disease deadly. Dental practitioners can often be on the frontlines of prevention of hypertension by evaluating preoperative blood pressure readings, performing risk assessments, and knowing when to consider medical consultation of a hypertensive patient in a dental setting. In addition, routine follow-up appointments and patients seen on an emergent basis, who may otherwise not be seen routinely, allow the oral health provider an opportunity to diagnose and refer for any unknown disease. It is imperative to understand the risk factors that may predispose patients to hypertension and to be able to educate them about their condition. Most importantly, the oral health care provider is in a pivotal position to play an active role in the management of patients presenting with a history of hypertension because many antihypertensive agents interact with pharmacologic agents used in the dental practice. The purpose of this review is to provide strategies for managing and preventing complications when treating the patient with hypertension who presents to the dental office.

SUMMARY Cerebrospinal fluid (CSF) immunoglobulins were measured in 62 normal children, in 9 children with purulent meningitis, and in 10 children with presumptive viral meningitis. The mean values in normal children were IgA 0, IgM 0, and IgG 0 84 ± 1 4 mg/100 ml (± SD). The mean levels of all CSF immunoglobulins were raised in acute bacterial meningitis and were significantly greater than the levels found in viral meningitis. CSF IgM was 0 16 ± 0 5 mg/100 ml in viral meningitis compared with 2 64 + 2 06 mg/100 ml in bacterial meningitis (P<0 01). However, these values overlapped to a considerable extent and, generally, measurement of CSF immunoglobulins did not enhance diagnostic accuracy in this group of children. Smith et al. (1973) presented data on CSF immunoglobulins in meningitis in adults, and suggested that the levels of IgM might help to distinguish viral from bacterial meningitis. Methods and materialCSF immunoglobulins were measured in 81 children aged between 0-1 and IOj years. The indications for spinal tap were meningitis, suspected meningitis, convulsions, or (for therapeutic purposes) leukaemia. The 62 children designated as normal had WBC <10 x 106/1 (<5 x 106/1 in all except 4), and normal CSF protein and glucose relative to age. Most of the children were being evaluated for suspected meningitis or because they had had febrile convulsions. Nine children were considered to have bacterial meningitis, of which 3 proved to be due to Haemophilus influenzae, 3 to Neisseria meningitidis, 1 to Staphylococcus albus, and 2 showed no growth on culture. In 10 children meningitis was presumed to be viral in origin on the basis of leucocyte response, CSF protein and glucose levels, and clinical course. Specific viral cultures were not performed.Lumbar puncture was performed as indicated on admission and the CSF analysed routinely in the laboratory. An unspun aliquot of the CSF was stored at 40C before the immunoglobulins were estimated. CSF immunoglobulins were measured without knowledge of the child's clinical or routine CSF findings. Cerebrospinal fluid samples which were grossly blood-stained or which contained RBC >100 x 106/1 were discarded.CSF immunoglobulins concentrations were measured by the radial immunodiffusion method (Mancini et al., 1965), using commercial L.C. Partigen plates and pooled human serum (Behring) as standard. 5 V.1 centrifuged, undiluted CSF was placed in the application wells and incubated for 72 hours at room temperature. Appropriate dilutions of standard in normal saline were also prepared. To intensify the precipitin ring the IgM and IgA plates were rinsed in phosphate-buffered saline for 24 hours, then covered with a 4% aqueous solution of tannin for 30 minutes and washed with distilled water. Standard curves were prepared from the square of the precipitin rings.Results Table 1 shows that IgA and IgM were not detected in Table 1 17-88 + 6-21 Conversion: traditional units to SI-CSF proteins: 1 mg/100 ml ;w 0.01 g/l, glucose: 1 mg/100 ml m 0-0555 mmol/l.

Background: Allogeneic bone marrow transplant (BMT) as well as liver, heart, and lung transplant patients have high reported incidence rates of Clostridioides difficile infection (CDI). The prevalence and incidence of asymptomatic colonization with Clostridioides difficile (ACCD) in this group is not known. Methods: ACCD was defined as the presence of C. difficile on screening cultures without positive clinical testing for CDI ±1 week from the date of sampling. Patients undergoing BMT as well as liver, heart, and lung transplants at MUSC between October 2017 and October 2019 were cultured for C. difficile at admission for transplant then once weekly during inpatient admissions and at each outpatient follow-up for 90 days after transplantation. Testing for CDI occurred at the discretion of treating physicians and was done by PCR. Transient ACCD was defined as a positive culture from samples collected <7 days apart, and persistent ACCD was defined as having 2 or more positive cultures collected a minimum of 7 days apart. Results: The baseline prevalences of ACCD were 1 of 5 (20%), 0 of 2 (0%), 1 of 40 (3%), and 2 of 16(13%) for lung, heart, liver and BMT patients, respectively. Of 63 patients, 3 had a pretransplant history of CDI, 2 of whom had baseline ACCD. Incident ACCD occurred in 23 of 63 patients (37%) (Table 1). Overall, ACCD was observed in 30 of 63 patients (48%). Of the 30 patients with ACCD, 14 displayed persistent asymptomatic colonization, whereas 16 displayed transient asymptomatic colonization. Also, 5 patients in the cohort were diagnosed with CDI after transplantation, of whom 3 had ACCD prior to or following CDI. Conclusions: The baseline prevalence of C. difficile colonization in transplant patients (6.3%) was not substantially greater than those observed in recent studies of hospitalized inpatients, but the incidence of new colonization events (37%) was high in this patient population with numerous pretransplant risk factors for CDI.Funding: NoneDisclosures: None

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