Hannamari Välimaa

Respiratory syncytial virus (RSV) causes respiratory illness among infants; maternal vaccination confers passive protection through placental antibody transfer. This phase 3, randomized, placebo-controlled trial evaluated safety, reactogenicity, and immunogenicity of RSV prefusion protein F3 maternal vaccine (RSVPreF3-Mat), administered at 24^0/7 to 36^0/7 weeks of gestation to high-risk pregnant women (women with obstetric complications and/or human immunodeficiency virus infection or in pregnant adolescents), and their infants up to 1 year post-birth. Enrollment was stopped and the study unblinded after an increased risk of preterm birth, associated with RSVPreF3 vaccine, was observed in another trial in healthy pregnant women. One hundred and sixty-nine maternal participants received either vaccine or placebo. No serious adverse events in maternal or infant participants were considered vaccine-related. Preterm birth occurred in 18.2% and 19.7% of participants in the vaccine and placebo groups, respectively, with one neonatal death in each group. In the vaccine group, increase in maternal neutralizing antibody titers against RSV subtype A and B was observed at Day 31 post-vaccination and remained high at delivery. Geometric mean ratio of titers at delivery over pre-vaccination for RSV A and B were 8.87- and 8.21-fold, respectively. Similarly, anti-RSVPreF3-Mat immunoglobulin G (IgG) levels showed increase at Day 31 post-vaccination and remained high at delivery (14.12-fold increase over pre-vaccination) with placental transfer ratio of RSVPreF3 IgG-specific antibodies at delivery of 1.33. In this study of high-risk pregnant women, RSVPreF3-Mat demonstrated an acceptable safety profile, induced robust immune responses with successful placental antibody transfer, and showed balanced rates of preterm birth between the groups. Trial registration: EudraCT: 2021-000994-96; NCT: NCT04980391.

Background: Beyond herpes simplex virus (HSV), the pathogenic role and occurrence of other human herpesviruses (HHVs) in the genitourinary tract remain largely unclear. This study aimed to determine the prevalence and level of shedding of nine typical human-infecting herpesviruses in genitourinary specimens of young women. Methods: We investigated the prevalence and quantity of HHVs using qPCR in urogenital samples from 380 women participating in a community-randomized human papillomavirus (HPV) vaccination trial and in a randomized trial on the effectiveness of Chlamydia trachomatis screening. Results: The prevalence of Epstein–Barr virus (EBV) DNA was the most frequent finding (8.4% positive). Other herpesvirus DNA was detected less frequently: HHV-6B in 5.8%, cytomegalovirus (CMV) in 3.7%, HHV-7 in 1.6%, HSV-2 in 0.8%, and HSV-1 in 0.5% of the specimens. The varicella–zoster virus (VZV), HHV-6A, and Kaposi’s sarcoma–associated herpesvirus (KSHV/HHV-8) DNA were not detected in any of the samples. Additionally, the prevalence of EBV DNA was significantly higher among women who tested positive for C. trachomatis based on a nucleic acid amplification test (NAAT) compared to those who tested negative (11.3% vs. 5.7%, p = 0.049). Similarly, EBV DNA was detected more frequently in women with DNA from sexually transmitted microbes in their samples (C. trachomatis, Mycoplasma genitalium, HPV, or HSV), with a prevalence of 11.4% compared to 4.0% (p = 0.0132). Conclusions: The increased prevalence of EBV DNA among young women with a sexually transmissible pathogen coinfection suggests more frequent shedding of EBV DNA among those with a sexually transmitted infection and likely higher sexual risk-taking behavior.

Objective: Third molar extraction is a common procedure with occasional complications. This study aimed to determine the incidence and types of complications in challenging lower third molar extractions and to identify complication risk factors in tertiary hospital patients. Material and methods: A retrospective cohort study was conducted on 354 patients who underwent unilateral lower third molar extraction during a 2-year period in 2018–2019 at Helsinki University Hospital. The outcome was the presence of a complication, and patient-related and operation-related variables served as determinants. Statistical analyses included Mann–Whitney U and Chi-squared tests, and binary logistic regression. Results: Complications occurred in 16.7% of patients. The most common complication was local infection (7.6%), followed by nerve injury (5.6%). The complication risk was 3.7-fold (95% confidence interval (CI) 1.97–6.77, p < 0.001) higher in extractions defined as demanding than in routine operative extraction. If the third molar was acutely infected, the complication risk increased 2.0-fold (95% CI 1.08–3.75, p = 0.027). Conclusions: Due to the high rate of complications in challenging extractions, scheduling a follow-up visit is important, and risk factors must be considered properly, especially in demanding extractions and in acutely infected third molars.

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral^® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients were randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, scaling and root planing, or NSPT with adjunctive Lumoral^® treatment. A complete clinical intraoral examination was conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BOP) was lower in the NSPT + Lumoral^®-group than in the NSPT group (p = 0.045), and more patients in the NSPT + Lumoral^®-group had their BOP below 10% (54% vs. 22%, respectively, p = 0.008). In addition, patients in the NSPT + Lumoral^®-group improved their oral hygiene by visible-plaque-index (p = 0.0003), while the NSPT group showed no statistical improvement compared to the baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT + Lumoral^® group (92% vs. 63%, p = 0.02). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT + Lumoral^®-group (71% vs. 33%, p = 0.01). Patients with initially less than ten deep pockets had fewer deep pockets at the three-month follow-up in the Lumoral^® group (p = 0.01). In conclusion, adjunctive use of Lumoral^® in NSPT results in improved treatment outcomes at three months post-therapy.

A single-site, randomized clinical trial was designed to determine the efficacy of regular home use of Lumoral® dual-light antibacterial aPDT in periodontitis patients. For the study, 200 patients are randomized to receive non-surgical periodontal treatment (NSPT), including standardized hygiene instructions and electric toothbrush, and scaling and root planing, or NSPT with adjunctive Lumoral® treatment. A complete clinical intraoral examination is conducted in the beginning, at three months, and at six months. This report presents the three-month results of the first 59 consecutive randomized subjects. At three months, bleeding on probing (BoP) was lower in the NSPT+Lumoral®-group than in the NSPT group (p=0.045), and more patients in the NSPT+Lumoral®-group had their BoP below 10% (52% vs. 29%, respectively, p=0.008). Patients in the NSPT+Lumoral®-group improved their oral hygiene by visible-plaque-index (p=0.0002), while the NSPT group showed no statistical improvement as compared to baseline. Both groups significantly reduced the number of deep periodontal pockets, but more patients with a reduction in their deep pocket number were found in the NSPT+Lumoral® group (92% vs. 63%, p=0.01). Patients whose number of deep pockets was reduced by 50% or more were also more frequent in the NSPT+Lumoral®-group (70% vs. 33%, p=0.01). Patients with initially less than ten deep pockets had fewer deep pockets at three-month follow-up in the Lumoral® group (p=0.02). In conclusion, adjunctive use of Lumoral® in NSPT results in improved treatment outcomes at three months post-therapy.

This paper describes and reports the patient-specific characteristics of an urgent dental care clinic for COVID-19 infected, suspected, exposed or quarantined patients from March to December 2020 i...

Nú eru næstum tvö ár liðin frá því að nýja kórónuveiran SARS-CoV-2 hóf að breiðast út um allan heim frá Wuhan í Kína og leiddi til heimsfaraldurs kórónuveirunnar (COVID-19). Einkenni COVID-19 geta verið allt frá vægum einkennum í öndunar- og meltingarfærum til alvarlegrar lungnabólgu og jafnvel dauða. Ný stökkbreytt afbrigði sem hafa hugsanlega í för með sér breytingar á klínískum eiginleikum, svo sem smithættu, alvarleika sjúkdóms og virkni bóluefnis, hafa reglulega komið fram. SARS-CoV-2 smitast fyrst og fremst með seyti frá öndunarvegum. Veiran finnst oft í munnvatni smitaðra sjúklinga, hvort sem þeir eru einkennalausir eða ekki. Það hefur valdið verulegum áhyggjum vegna hættu á smiti milli tannlækna og sjúklinga við tannlæknaþjónustu. Því var aðgangur að tannlæknaþjónustu sem ekki var brýn mjög takmarkaður í upphafi heimsfaraldursins. Af því leiðir að uppsöfnuð þörf er á tannlæknaþjónustu og hætta á að tafir verði á meðferð. SARS-CoV-2 veiran getur borist í þekjufrumur í munnholi og munnvatnskirtla. Enn sem komið er eru engar vísbendingar um að SARS-CoV-2 sýking í munnholi hafi verið staðfest með veirugreiningu. Vísbendingar eru um að slök munn- og tannheilsa, einkum tannhaldsbólga, geti gert COVID-19 sýkingu verri. Það getur gerst með þeim hætti að bakteríur í munnholi berist í öndunarveg og valdi þannig samsýkingu, eða vegna altæks bólguástands af völdum tannhaldsbólgu. Þörf er á frekari rannsóknum til að meta hugsanleg áhrif SARS-CoV-2 veirunnar á munnheilsu og almennt heilbrigði. Lykilorð: SARS-CoV-2, COVID-19, munnvatn, munnslímhúð, munnvatnskirtlar, smitvarnir

Objectives Association was investigated between oral health before dialysis and the incidence of systemic infections during dialysis. We hypothesized that low-grade systemic inflammation caused by poor oral health associates with infectious episodes in patients on dialysis, despite earlier eradication of oral infection foci. Subjects and methods A total of 117 patients (46 with peritoneal and 71 with hemodialysis) were examined and treated at predialysis stage and followed up during dialysis. Number of infection episodes and microorganisms cultured from blood and peritoneal fluid were analyzed. Number of teeth, periodontal inflammatory burden, and total dental index scores were assessed, and salivary matrix metalloproteinase 8, triggering receptor on myeloid cells 1, peptidoglycan recognition protein 1 (PGLYRP1), and interleukin-1 beta were measured. Results In hemodialysis, 134 infection episodes were recorded, while peritoneal dialysis group had 77 peritonitis episodes. Culture-negative samples were 69% in hemodialysis and 23% in peritoneal dialysis group. Staphylococci were the most frequently associated microorganisms. Infections during dialysis did neither associate with oral health parameters nor associate with salivary inflammatory biomarkers, except for PGLYRP1, which associated with number of infection episodes during hemodialysis (p = .046). Conclusions A number of infection episodes during hemodialysis were associated with salivary PGLYRP1 but not the other salivary markers or oral infection markers.

Infections with the nine human herpesviruses (HHVs) are globally prevalent and characterized by lifelong persistence. Reactivations can potentially manifest as life-threatening conditions for which the demonstration of viral DNA is essential. In the present study, we developed HERQ-9, a pan-HHV quantitative PCR designed in triplex reactions to differentiate and quantify each of the HHV-DNAs: (i) herpes simplex viruses 1 and 2 and varicella-zoster virus; (ii) Epstein-Barr virus, human cytomegalovirus, and Kaposi’s sarcoma-associated herpesvirus; and (iii) HHV-6A, -6B, and -7. The method was validated with prequantified reference standards as well as with mucocutaneous swabs and cerebrospinal fluid, plasma, and tonsillar tissue samples. Our findings highlight the value of multiplexing in the diagnosis of many unsuspected, yet clinically relevant, herpesviruses. In addition, we report here frequent HHV-DNA co-occurrences in clinical samples, including some previously unknown. HERQ-9 exhibited high specificity and sensitivity (LOD₉₅s of ∼10 to ∼17 copies/reaction), with a dynamic range of 10¹ to 10⁶ copies/μl. Moreover, it performed accurately in the coamplification of both high- and low-abundance targets in the same reaction. In conclusion, we demonstrated that HERQ-9 is suitable for the diagnosis of a plethora of herpesvirus-related diseases. Besides its significance to clinical management, the method is valuable for the assessment of hitherto-unexplored synergistic effects of herpesvirus coinfections. Furthermore, its high sensitivity enables studies on the human virome, often dealing with minute quantities of persisting HHVs. IMPORTANCE By adulthood, almost all humans become infected by at least one herpesvirus (HHV). The maladies inflicted by these microbes extend beyond the initial infection, as they remain inside our cells for life and can reactivate, causing severe diseases. The diagnosis of active infection by these ubiquitous pathogens includes the detection of DNA with sensitive and specific assays. We developed the first quantitative PCR assay (HERQ-9) designed to identify and quantify each of the nine human herpesviruses. The simultaneous detection of HHVs in the same sample is important since they may act together to induce life-threatening conditions. Moreover, the high sensitivity of our method is of extreme value for assessment of the effects of these viruses persisting in our body and their long-term consequences on our health.

Objectives: Chronic rhinosinusitis (CRS) frequently stems from a dental origin, although odontogenic sinusitis (OS) remains underdiagnosed amongst different professionals. This study aimed to explore how often odontogenic causes are considered when diagnosing CRS. Materials and methods: Patient records from 374 new CRS patients treated at a tertiary-level ear, nose, and throat (ENT) clinic were selected. Entries and radiological reports were assessed exploring how often dentition was mentioned and OS was suspected, how often radiologists reported maxillary teeth, and how commonly typical OS microbial findings and unilateral symptoms occurred. Results: Although 10.1% of the CRS diagnoses were connected to possible dental issues, teeth were not mentioned for 73.8% of patients. Radiological reports were available from 267 computed or cone beam computed tomographies, of which 25.1% did not mention the maxillary teeth. The reported maxillary teeth pathology was not considered in 31/64 (48.4%) cases. Unilateral symptoms associated with apical periodontitis (OR = 2.49, 95% CI 1.27–4.89, p = 0.008). Microbial samples were available from 88 patients, for whom Staphylococcus aureus was the most common finding (17% of samples). Conclusions: Odontogenic causes are often overlooked when diagnosing CRS. To provide adequate treatment, routine assessment of patient’s dental history and status, careful radiograph evaluation, and utilization of microbial findings should be performed. Close cooperation with dentists is mandatory. Clinical relevance: Dental professionals should be aware of difficulties medical professionals encounter when diagnosing possible OS. Thus, sufficient knowledge of OS pathology is essential to both medical and dental professionals.