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1
Haba, Danisia, Yllka Decolli, Emilia Marciuc, and Ana Elena Sîrghe. "Teeth Impaction and Structural Teeth Anomalies." Seminars in Musculoskeletal Radiology 24, no. 05 (October 2020): 523–34. http://dx.doi.org/10.1055/s-0040-1709210.
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AbstractDentists and oral and maxillofacial radiologists have used periapical, occlusal, panoramic, and cephalometric radiographs for many years for diagnosing dental anomalies, especially before orthodontic or surgical treatment. Cone beam computed tomography was developed in recent years especially for the dental and maxillofacial region. Thus it has become the imaging modality of choice for many clinical situations, such as the assessment of dental impaction and structural teeth anomalies or other associated diseases and disorders (e.g., Gardner's syndrome, cleidocranial dysplasia). This article reviews different aspects of dental impaction and its possible effects on adjacent structures such as external root resorption, marginal bone loss, as well as describing structural dental anomalies. It provides a systematic analysis of their characteristic features and imaging findings for general radiologists to achieve a precise diagnosis and an optimal interpretation.
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Bán, Ágnes, Zsolt Ferenc Németh, Adrienn Szauter, Szilvia Soós, and Márta Balaskó. "A krónikus parodontitis, illetve szájnyálkahártya-laesiók előfordulása és súlyossága krónikus obstruktív tüdőbetegségben." Orvosi Hetilap 159, no. 21 (May 2018): 831–36. http://dx.doi.org/10.1556/650.2018.31037.
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Abstract: Introduction: Chronic parodontitis is a prevalent oral disease that may lead to the loss of teeth independently of caries. Some systemic diseases (e.g., diabetes mellitus, chronic renal failure) may aggravate chronic parodontitis. On the other hand, this oral disease may aggravate other systemic diseases. Earlier studies suggested a correlation between chronic parodontitis and very severe chronic obstructive pulmonary disease (COPD). Aim: The aim of our study was the investigation of the correlation between chronic parodontitis and chronic obstructive pulmonary disease. Method: We have recruited patients of the Department of Dentistry, Oral and Maxillofacial Surgery, Medical School, University of Pécs, in the study. Volunteers were assigned into a COPD (n = 29) and control group (n = 45). Airflow limitation of the COPD group (FEV1/FVC: 61.52 ± 3.2%) corresponded to GOLD 2 (global initiative for chronic obstructive lung disease; FEV1: 52.66 ± 3.57%). Oral health assessment included mean and maximal clinical attachment loss, mobility of teeth, decayed/filled and missing teeth, Löe–Silness, oral hygiene and bleeding on probing indexes. One-way ANOVA and non-parametric Mann–Whitney tests were used for statistical analysis. Results: Oral health of the COPD group was worse than that of the controls. In this group the mean and maximal clinical attachment loss, mobility of teeth, the Löe–Silness, the oral hygiene and bleeding on probing indexes were higher. Conclusions: Our results confirm the positive correlation between chronic parodontitis and a moderate level of chronic obstructive pulmonary disease. However, it is not clear whether the COPD-associated systemic inflammation aggravated the oral status or the chronic parodontitis influenced negatively chronic obstructive pulmonary disease. Orv Hetil. 2018; 159(21): 831–836.
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Madhu, Priyanka Paul. "AN OVERVIEW: INSIGHT OF DENTAL BLEACHING AGENTS." Journal of Medical pharmaceutical and allied sciences 10, no. 4 (September 15, 2021): 3182–86. http://dx.doi.org/10.22270/jmpas.v10i4.1253.
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The virtue of the "perfect smile" is an easily achievable task with a better understanding of materials and diseases as well as advances in technology. Discoloured teeth can often be completely or partially corrected by whitening as it is conservative, non-invasive, and inexpensive, it is the treatment protocol of choice for the masses. Hydrogen and carbamide peroxides have been used successfully for many years; the teeth whitening technique has changed several times over the past century, and nearly 10 years before the new millennium, the technique was finally recognized by international regulatory agencies. It is important that dentists handle peroxides with a basic knowledge as it has been shown that the results will give satisfactory results. This technique depends on correctly diagnosing the stains, handling the substrates (enamel and dentin), and sensitivity. Dentists are exposed to a wide variety of teeth whitening techniques, products, and brands, and mild peroxide activation devices have been developed over the past two decades. The art is also currently subject to change depending on the effectiveness of the various light sources inactivating peroxide and their relationship to satisfactory end results. To achieve instant whitening without risk or relapse, innovative technologies and promising products have been developed. This article is intended to keep up to date with these new trends providing insight into the current clinical challenges of vital teeth whitening. The purpose of this literature review is to explain the determining factors influencing the successful end-results of the techniques and to provide an overview in order to make an evidence-based treatment decision.
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Băilă, Diana Irinel, Oana Catalina Mocioiu, and Marian Gheorghe. "Characteristics of Dental Microsurgery Instruments for a Database System." Applied Mechanics and Materials 760 (May 2015): 51–56. http://dx.doi.org/10.4028/www.scientific.net/amm.760.51.
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In dental microsurgery, different dental instruments are used for teeth microsurgery and related diseases. The dental instruments materials are very different, e.g., plastics, stainless steel, titanium alloy, cobalt chrome alloys, diamond powders. The dental instruments materials must be nontoxic for the human body, with good corrosion resistance, mechanical strength and aging resistance, as well a high degree of cleanliness to allow sterilization in good conditions. Few representative dental microsurgery instruments, as well as relevant characteristics of some specific materials are presented.
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Pei, Yaolin, and Bei Wu. "Risk Factors of Orofacial Pain Symptoms Among Older Adults at the End of Life." Innovation in Aging 4, Supplement_1 (December 1, 2020): 832–33. http://dx.doi.org/10.1093/geroni/igaa057.3048.
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Abstract The aims of this study were to examine the prevalence of orofacial pain symptoms in Chinese older adults at the end of life, and to investigate risk factors related to orofacial pain. The sample derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a national respresentative sample of the oldest-old. The results showed that the 6-month prevalence of pain when chewing or biting at the end of life was 11.1%, and the rate was 5% for jaw joint pain/facial pain. Lower SES, smokers, and having chronic diseases were associated with having orofacial symptoms. Unexpectedly, the results revealed that dentate older adults (retain at least one natural tooth) who brushed their teeth more often were more likely to have orofacial symptoms. Older adults have poor oral health, particularly at the end of their life. This study highlights the importance of improving oral health for vulnerable older adults.
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Cakic, Sasa. "Gingival crevicular fluid in the diagnosis of periodontal and systemic diseases." Srpski arhiv za celokupno lekarstvo 137, no. 5-6 (2009): 298–303. http://dx.doi.org/10.2298/sarh0906298c.
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Gingival crevicular fluid (GCF) can be found in the physiologic space (gingival sulcus), as well as in the pathological space (gingival pocket or periodontal pocket) between the gums and teeth. In the first case it is a transudate, in the second an exudate. The constituents of GCF originate from serum, gingival tissues, and from both bacterial and host response cells present in the aforementioned spaces and the surrounding tissues. The collection and analysis of GCF are the noninvasive methods for the evaluation of host response in periodontal disease. These analyses mainly focus on inflammatory markers, such as prostaglandin E2, neutrophil elastase and ?-glucuronidase, and on the marker of cellular necrosis - aspartat aminotransferase. Further, the analysis of inflammatory markers in the GCF may assist in defining how certain systemic diseases (e.g., diabetes mellitus) can modify periodontal disease, and how peridontal disease can influence certain systemic disorders (atherosclerosis, preterm delivery, diabetes mellitus and some chronic respiratory diseases). Major factors which influence the results obtained from the analyses of GCF are not only the methods of these analyses, but the method of GCF collection as well. As saliva collection is less technique-sensitive than GCF collection, some constituents of saliva which originate from the GCF can be analyzed as more amenable to chairside utilization.
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Kallio, Jouko, Timo Kauppila, Lasse Suominen, and Anna Maria Heikkinen. "A Competition between Care Teams Improved Recording of Diagnoses in Primary Dental Care: A Longitudinal Follow-Up Study." International Journal of Dentistry 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/3080957.
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Introduction. A playful competition was launched in a primary dental health care system to improve the recording of diagnoses into an electronic patient chart system and to study what diagnoses were used in primary dental care.Methods. This was a longitudinal follow-up study with public sector primary dental care practices in a Finnish city. A one-year-lasting playful competition between the dental care teams was launched and the monthly percentage of dentists’ visits with recorded diagnosis before, during, and after the intervention was recorded. The assessed diagnoses were recorded with the International Classification of Diseases (ICD-10).Results. Before the competition, the level of diagnosis recordings was practically zero. At the end of this intervention, about 25% of the visits had a recorded diagnosis. Two years after the competition, this percentage was 35% without any additional measures. The most frequent diagnoses were dental caries (K02, 38.6%), other diseases of hard tissues of teeth (K03, 14.8%), and diseases of pulp and periapical tissues (K04, 11.4%).Conclusions. Commitment to the idea that recording of diagnoses was beneficial improved the recording of dental diagnoses. However, the diagnoses obtained did not accurately reflect the reputed prevalence of oral diseases in the Finnish population.
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Zubery, Yuval, Colin R. Dunstan, Beryl M. Story, Lakshmyya Kesavalu, Jeffrey L. Ebersole, Stanley C. Holt, and Brendan F. Boyce. "Bone Resorption Caused by Three Periodontal Pathogens In Vivo in Mice Is Mediated in Part by Prostaglandin." Infection and Immunity 66, no. 9 (September 1, 1998): 4158–62. http://dx.doi.org/10.1128/iai.66.9.4158-4162.1998.
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ABSTRACT Gingival inflammation, bacterial infection, alveolar bone destruction, and subsequent tooth loss are characteristic features of periodontal disease, but the precise mechanisms of bone loss are poorly understood. Most animal models of the disease require injury to gingival tissues or teeth, and the effects of microorganisms are thus complicated by host responses to tissue destruction. To determine whether three putative periodontal pathogens, Porphyromonas gingivalis, Campylobacter rectus, andFusobacterium nucleatum, could cause localized bone resorption in vivo in the absence of tissue injury, we injected live or heat-killed preparations of these microorganisms into the subcutaneous tissues overlying the calvaria of normal mice once daily for 6 days and then examined the bones histologically. We found that all three microorganisms (both live and heat killed) stimulated bone resorption and that the strain of F. nucleatum used appeared to be the strongest inducer of osteoclast activity. Treatment of the mice concomitantly with indomethacin reduced but did not completely inhibit bone resorption by these microorganisms, suggesting that their effects were mediated, in part, by arachidonic acid metabolites (e.g., prostaglandins). Our findings indicate that these potential pathogens can stimulate bone resorption locally when placed beside a bone surface in vivo in the absence of prior tissue injury and support a role for them in the pathogenesis of bone loss around teeth in periodontitis.
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Jang, Yuri, Nan Sook Park, Min-Kyoung Rhee, Hyunwoo Yoon, Yong Ju Cho, miyong T. Kim, and David A. Chiriboga. "PHYSICAL-MENTAL-ORAL-COGNITIVE HEALTH IN OLDER KOREAN AMERICANS: A MULTISITE STUDY." Innovation in Aging 3, Supplement_1 (November 2019): S406. http://dx.doi.org/10.1093/geroni/igz038.1510.
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Abstract Using data from surveys with older Korean Americans (n = 2,150) conducted at five sites in the U.S. (California, New York, Texas, Hawaii, and Florida), the present study explored the status of physical/mental/oral/cognitive health and its determinants. For each health domain, we examined how self-rating (excellent/very good/good/fair/poor) of health was associated with other domain-relevant indicators (e.g., the number of chronic diseases, symptoms of depression, problems with teeth or gums, or cognitive performance) and sociocultural factors (e.g., socioeconomic status, acculturation, social network, and social cohesion). Geographic variation was also considered. The correlations between self-ratings and domain-relevant indicators in all health domains were significant but moderate. A series of multivariate regression models of self-ratings of physical/mental/oral/cognitive health not only confirmed the effect of the domain-relevant health indicators but also demonstrated a critical contribution of sociocultural determinants. Implications for older immigrants were discussed in terms of place, culture, and context.
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Begum, Mahjabeen Sultana, Mohammad Zaid Hossain, Sudip Ranjan Deb, Md Mosaraf Hossain Khan, Mostafizur Rahman, and Khan Abul Kalam Azad. "Health care practice and life pattern of elderly women attending in a selected geriatric hospital in Dhaka city." Journal of Dhaka Medical College 22, no. 1 (July 6, 2013): 30–33. http://dx.doi.org/10.3329/jdmc.v22i1.15602.
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Objective: The study was carried out to find out the health care seeking practice among the elderly women attending a selected hospital in Dhaka city. Materials and methods: This was a cross sectional study and included 164 women aged 60 years and above. The study was carried out from March to June, 2001, at Prabin Hitayishi Hospital, Bangladesh Associated of Aged and Institute of Geriatric Medicine (BAAIGM), Agargaon, Sher E Bangla Nagar, Dhaka. Results: In the present study, 58.5% women were aged less than 65 years, 51.2% were illiterates, 65.9% were married, only 7.3% were living with their spouse, 86.6% were housewives, only 9.8% had self income, 25.6% were earning between Taka 10,001 and 15,000 per month, and 41.5% were staying in families with 7 8 members, 90.2% had regular daily bath, 80.5% with soap, 90.2% brushed their teeth at least once a day, only 12.2% were taking regular exercise, 70.7% had knowledge about self health care, however, only 22% were on regular health check up, 12.2% women thought egg, milk, fish, meat and fruits were good for health. Regarding old age diseases, 43.9% knew about diabetes, 39% high blood pressure, 36.6% heart, 17.1% respiratory and 2.4% orthopaedic diseases. Most common diseases were eye (26.8%), cardiovascular and orthopaedic (19.5%) and ENT (14.6%). Other diseases were gastrointestinal (9.8%), respiratory (7.1%), dental and endocrine (4.9%). Conclusion: Old women of our society should be made aware on old age diseases and self health care practices. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15602 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 30-33
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Islam, Nabhira Aftabi Binte, and Mahmudul Haque. "PP185 Oral Health Status And Food Consumption Patterns In Selected Primary School Children." International Journal of Technology Assessment in Health Care 36, S1 (December 2020): 19–20. http://dx.doi.org/10.1017/s0266462320001361.
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IntroductionNutrition is critical to the oral health of the individual. From gestation through to end of life, nutrition influences the integrity and function of the dentition and supporting oral structures and has a direct effect on health in general. According to the World Health Organization, diet has an important role in the prevention of oral diseases such as dental caries, dental erosion, defects in oral development, diseases of the oral mucosa, and periodontal disease.MethodsA study was conducted to assess the oral health status and food consumption patterns of students attending the Rotary School and College at Mirpur-14, Dhaka on November 2018. Consent was provided by the school headmaster and guardians. A purposive sample of seventy students was taken. A semi-structured questionnaire and checklist was developed in the English and Bengali languages. Data were presented in simple frequency tables.ResultsAmong the respondents the following eating habits were reported: (i)Thirty-one percent drank milk and twenty-eight percent consumed chocolate four to six times per week;(ii)Forty-three percent consumed fast food least seven times per week; and(iii)Forty-two percent ate vegetables and thirty-four percent ate fruits one to three times per week.In terms of oral hygiene practices, sixty-one percent of respondents used toothpaste and thirty-nine percent used tooth powder. Seventy-eight percent of respondents brushed their teeth once a day and twenty-four percent brushed twice daily. The mean number of decayed, missing (due to caries), and filled permanent teeth was 1.47.ConclusionsThe relationship between oral health, dietary practices, nutritional status, and general health is complex, with many interrelated factors. To help children develop healthy eating patterns from an early age, it is important that the food and eating patterns to which they are exposed, both inside and outside the home, promote positive attitudes to good nutrition.
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Endo, Takeshi, Kenju Akai, Tsunetaka Kijima, Shigetaka Kitahara, Takafumi Abe, Miwako Takeda, Toru Nabika, Shozo Yano, and Minoru Isomura. "An association analysis between hypertension, dementia, and depression and the phases of pre-sarcopenia to sarcopenia: A cross-sectional analysis." PLOS ONE 16, no. 7 (July 22, 2021): e0252784. http://dx.doi.org/10.1371/journal.pone.0252784.
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Sarcopenia is intricately related to aging associated diseases, such as neuropsychiatric disorders, oral status, and chronic diseases. Dementia and depression are interconnected and also related to sarcopenia. The preliminary shift from robust to sarcopenia (i.e., pre-sarcopenia) is an important albeit underdiscussed stage and is the focus of this study. Identifying factors associated with pre-sarcopenia may lead to sarcopenia prevention. To separately examine the effects of dementia and depression on pre-sarcopenia/sarcopenia, we conducted multiple analyses. This cross-sectional study used health checkup data from a rural Japanese island. The participants were aged 60 years and above, and the data included muscle mass, gait speed, handgrip strength, oral status (teeth and denture), chronic diseases (e.g., hypertension), dementia (cognitive assessment for dementia, iPad Version), and depression (self-rating depression scale). A total of 753 older adult participants were divided into the sarcopenia (n = 30), pre-sarcopenia (n = 125), and robust (n = 598) groups. An ordered logit regression analysis indicated that age and depression were positively correlated with sarcopenia, while hypertension was negatively associated with it. A multiple logistic regression analysis between the robust and pre-sarcopenia groups showed significant associations between the same three variables. Depression was associated with pre-sarcopenia, but not dementia. There was also a significant association between hypertension and pre-sarcopenia. Further research is needed to reveal whether the management of these factors can prevent sarcopenia.
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Abdul Aziz, Azrul Hafiz. "New Water Irrigator For Cleaning Dental Plaque." International Journal for Innovation Education and Research 6, no. 10 (October 31, 2018): 299–305. http://dx.doi.org/10.31686/ijier.vol6.iss10.1190.
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Patient with fixed appliances (braces) must have good oral hygiene to prevent dental caries, decalcification, periodontal problems and oral health diseases. Many orthodontic patients’ complaint of not able to clean between their fixed appliances (braces) due to the arch wires prevented the insertion of the toothbrush. Food can also get stuck between the fixed appliances and their teeth. This could result in dental cavity and gum disease for this patient if left untreated. In this study, a new device of tooth cleaning was tested against normal tooth brushing. A new cleaning device which uses water irrigation to remove dental plaque on tooth enamel surfaces were develop for this study. Both method of tooth cleanings was compared between each other on the effectiveness to remove dental plaque on tooth enamel surfaces. In the end, water irrigator was found to be slightly more effective to clean dental plaque.
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Boikos, Constantina, Gregg C. Sylvester, John S. Sampalis, and James A. Mansi. "Relative Effectiveness of the Cell-Cultured Quadrivalent Influenza Vaccine Compared to Standard, Egg-derived Quadrivalent Influenza Vaccines in Preventing Influenza-like Illness in 2017–2018." Clinical Infectious Diseases 71, no. 10 (April 7, 2020): e665-e671. http://dx.doi.org/10.1093/cid/ciaa371.
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Abstract Background Influenza antigens may undergo adaptive mutations during egg-based vaccine production. In the 2017–2018 influenza season, quadrivalent, inactivated cell-derived influenza vaccine (ccIIV4) vaccine was produced using A(H3N2) seed virus propagated exclusively in cell culture, thus lacking egg adaptive changes. This United States study estimated relative vaccine effectiveness (rVE) of ccIIV4 vs egg-derived quadrivalent vaccines (egg-derived IIV4) for that season. Methods Vaccination, outcome, and covariate data were ascertained retrospectively from a electronic medical record (EMR) dataset and analyzed. The study cohort included patients ≥ 4 years of age. rVE was estimated against influenza-like illness (ILI) using diagnostic International Classification of Diseases, Ninth or Tenth Revision codes. The adjusted odds ratios used to derive rVE estimates were estimated from multivariable logistic regression models adjusted for age, sex, race/ethnicity, geographic region, and health status. Results Overall, 92 187 individuals had a primary care EMR record of ccIIV4 and 1 261 675 had a record of egg-derived IIV4. In the ccIIV4 group, 1705 narrowly defined ILI events occurred, and 25 645 occurred in the standard egg-derived IIV4 group. Crude rVE was 9.2% (95% confidence interval [CI], 4.6%–13.6%). When adjusted for age, sex, health status, comorbidities, and geographic region, the estimated rVE changed to 36.2% (95% CI, 26.1%–44.9%). Conclusions ccIIV4, derived from A(H3N2) seed virus propagated exclusively in cell culture, was more effective than egg-derived IIV4 in preventing ILI during the 2017–2018 influenza season. This result suggests that cell-derived influenza vaccines may have greater effectiveness than standard egg-derived vaccines.
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Nai, Gisele Alborghetti, Maria Luiza de Toledo Stuani, and Luís Antonio Sasso Stuani. "Oral cavity eumycetoma." Revista do Instituto de Medicina Tropical de São Paulo 53, no. 3 (June 2011): 165–68. http://dx.doi.org/10.1590/s0036-46652011000300008.
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Mycetoma is a pathological process in which eumycotic (fungal) or actinomycotic causative agents from exogenous source produce grains. It is a localized chronic and deforming infectious disease of subcutaneous tissue, skin and bones. We report the first case of eumycetoma of the oral cavity in world literature. CASE REPORT: A 43-year-old male patient, complaining of swelling and fistula in the hard palate. On examination, swelling of the anterior and middle hard palate, with fistula draining a dark liquid was observed. The panoramic radiograph showed extensive radiolucent area involving the region of teeth 21-26 and the computerized tomography showed communication with the nasal cavity, suggesting the diagnosis of periapical cyst. Surgery was performed to remove the lesion. Histopathological examination revealed purulent material with characteristic grain. Gram staining for bacteria was negative and Grocott-Gomori staining for the detection of fungi was positive, concluding the diagnosis of eumycetoma. The patient was treated with ketoconazole for nine months, and was considered cured at the end of treatment. CONCLUSION: Histopathological examination, using histochemical staining, and direct microscopic grains examination can provide the distinction between eumycetoma and actinomycetoma accurately.
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Oz, Helieh S., and David A. Puleo. "Animal Models for Periodontal Disease." Journal of Biomedicine and Biotechnology 2011 (2011): 1–8. http://dx.doi.org/10.1155/2011/754857.
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Animal models and cell cultures have contributed new knowledge in biological sciences, including periodontology. Although cultured cells can be used to study physiological processes that occur during the pathogenesis of periodontitis, the complex host response fundamentally responsible for this disease cannot be reproducedin vitro. Among the animal kingdom, rodents, rabbits, pigs, dogs, and nonhuman primates have been used to model human periodontitis, each with advantages and disadvantages. Periodontitis commonly has been induced by placing a bacterial plaque retentive ligature in the gingival sulcus around the molar teeth. In addition, alveolar bone loss has been induced by inoculation or injection of human oral bacteria (e.g.,Porphyromonas gingivalis) in different animal models. While animal models have provided a wide range of important data, it is sometimes difficult to determine whether the findings are applicable to humans. In addition, variability in host responses to bacterial infection among individuals contributes significantly to the expression of periodontal diseases. A practical and highly reproducible model that truly mimics the natural pathogenesis of human periodontal disease has yet to be developed.
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McLachlan, Julia L., Alastair J. Sloan, Anthony J. Smith, Gabriel Landini, and Paul R. Cooper. "S100 and Cytokine Expression in Caries." Infection and Immunity 72, no. 7 (July 2004): 4102–8. http://dx.doi.org/10.1128/iai.72.7.4102-4108.2004.
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ABSTRACT The molecular immune response of the pulpal tissue during chronic carious infection is poorly characterized. Our objective was to examine the expression of potential molecular mediators of pulpal inflammation, correlate their levels with disease severity, and determine the cellular localization of key molecules. Results indicated that there was significantly increased transcriptional activity in carious compared to healthy pulp, and the increase correlated positively with disease severity. Semiquantitative reverse transcriptase PCR analysis in 10 carious and 10 healthy pulpal tissue samples of the S100 family members S100A8, S100A9, S100A10, S100A12, and S100A13; the cytokines tumor necrosis factor alpha (TNF-α), interleukin-1β (IL-1β), IL-8, IL-6, and epithelial cell-derived neutrophil attractant 78 (ENA-78); and the structural protein collagen-1α indicated that all genes tested, with the exception of S100A10, were more abundantly expressed in carious teeth. In addition, we found that the closer the carious lesion front was to the pulpal chamber the higher the expression was for all genes except S100A10. Multiple-regression analysis identified a significant positive correlation between the expression levels of S100A8 and IL-1β, ENA-78, and IL-6 and between collagen-1α and S100A8, TNF-α, IL-1β, IL-8, IL-6, and ENA-78. Immunohistochemical studies in carious pulpal tissue indicated that S100A8 and the S100A8/S100A9 complex were predominantly expressed by infiltrating neutrophils. Gene expression analyses in immune system cells supported these findings and indicated that bacterial activation of neutrophils caused upregulation of S100A8, S100A9, and S100A13. This study highlights the complex nature of the molecular immune response that occurs during carious infection.
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Ippolitov, Yu A., E. N. Bondareva, M. E. Kovalenko, E. Yu Zolotareva, and M. M. Tatarintsev. "Comprehensive approach to treatment of malocclusion in children with different degree of caries resistance." Pediatric dentistry and dental profilaxis 20, no. 3 (October 10, 2020): 191–98. http://dx.doi.org/10.33925/1683-3031-2020-20-3-191-198.
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Relevance. Skeletal malocclusion stands at the head of all oral diseases and is encountered in 32-35% of children and adolescents in Russia [7;12;15]. The number of malocclusions has increase due to various reasons, one of which is early extraction of deciduous carious teeth resulting in impaired vertical dimension and occlusion of teeth [1;14]. Diagnosis with due regard to caries resistance degree and planning of respective operative and orthodontic treatment are indispensable in children with skeletal malocclusion. Purpose – to increase effectiveness of functional treatment of malocclusion in children with various degree of caries resistance.Materials and methods. There were examined 108 patients aged between 6 and 16 with Class I malocclusion according to Angle, abnormal arch-to-arch relationship and tooth position and various degree of caries resistance. 4 groups were formed: high, sufficient mean, decreased mean and low caries resistance of dental enamel. Intensity of carious process was detected in all patients before and after orthodontic treatment. The effectiveness of reminerlization administered by removable orthodontic appliances was evaluated by electrometrical testing of hard dental tissue. Surface EMG was used to assess normalization of tone of maxillofacial muscles in children by average amplitude of biopotentials of superficial masseter and temporalis muscles.Results. Сhanges in caries intensity in children after treatment with removable orthodontic aligners indicate the necessity for remineralization of hard dental tissues during orthodontic treatment and it is confirmed by decrease of electroconductivity of enamel in children with sufficient mean, decreased mean and low degree of dental enamel caries resistance. Increase of biopotential mean amplitude during «total mastication» for masseter and temporal muscles confirms effectiveness of preformed elastic positioner along with myodynamic exercises.Conclusions. The conducted study proves the necessity of comprehensive approach with procedures increasing the degree of caries resistance of hard dental tissues during orthodontic treatment of skeletal malocclusion in children.
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Mangelsdorf, Inge, Harald Walach, and Joachim Mutter. "Healing of Amyotrophic Lateral Sclerosis: A Case Report." Complementary Medicine Research 24, no. 3 (2017): 175–81. http://dx.doi.org/10.1159/000477397.
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Background: Amyotrophic lateral sclerosis (ALS) is a devastating disease leading to death within 3-5 years in most cases. New approaches to treating this disease are needed. Here, we report a successful therapy. Case Report: In a 49-year-old male patient suffering from muscle weakness and fasciculations, progressive muscular atrophy, a variant of ALS, was diagnosed after extensive examinations ruling out other diseases. Due to supposed mercury exposure from residual amalgam, the patient's teeth were restored. Then, the patient received sodium 2,3-dimercaptopropanesulfate (DMPS; overall 86 × 250 mg in 3 years) in combination with α-lipoic acid and followed by selenium. In addition, he took vitamins and micronutrients and kept a vegetarian diet. The excretion of metals was monitored in the urine. The success of the therapy was followed by scoring muscle weakness and fasciculations and finally by electromyography (EMG) of the affected muscles. First improvements occurred after the dental restorations. Two months after starting therapy with DMPS, the mercury level in the urine was increased (248.4 µg/g creatinine). After 1.5 years, EMG confirmed the absence of typical signs of ALS. In the course of 3 years, the patient recovered completely. Conclusions: The therapy described here is a promising approach to treating some kinds of motor neuron disease and merits further evaluation in rigorous trials.
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Puzin, S. N., I. V. Pryanikov, N. B. Vanchenko, K. G. Karakov, and M. A. Shurgaya. "MEDICAL AND SOCIAL ASPECTS OF CHRONIC GENERAL PARODONTITIS." Medical and Social Expert Evaluation and Rehabilitation 21, no. 3-4 (December 15, 2018): 129–33. http://dx.doi.org/10.18821/1560-9537-2018-21-3-4-129-133.
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A healthy smile is one of the main components of a person’s attractiveness, which makes it possible to improve the quality of communication with others in a personal and social aspect. Dental health depends on the state of the periodontal complex. The vast majority of people of different ages suffer from periodontal disease and seek dental care. The significant prevalence, the adverse effect of foci of periodontal infection on the body, the large loss of teeth cause both medical and social significance of this problem. In this regard, the tasks for the treatment of inflammatory diseases of periodontal tissues are determined before the dentist. The treatment of gingivitis and periodontitis is a complex and lengthy process that requires a comprehensive approach from the dentist, finding new remedies and methods of treatment. The article presents the results of the treatment of chronic generalized periodontitis of moderate severity using the drug “Galavit”. After the course of treatment, the index indicators reflected the achievement of positive dynamics. The content of the total aerobic and anaerobic microflora of the periodontal pockets was eliminated 1.5 - 2 times. In the comparison group in the dynamics of treatment to the end of therapy, there was a decrease in the number of aerobic and anaerobic microorganisms to etiologically significant indicators. The results of the study indicate the superiority of the use of complex therapeutic measures with the use of the drug “Galavit” over the traditional treatment of chronic generalized periodontitis of moderate severity. It is proposed for practicing dentists to use the drug in question in a complex scheme for the treatment of periodontal tissue diseases, since this drug has shown its high clinical efficacy.
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Чунихин, Андрей, Andrey Chunihin, Эрнест Базикян, and Ernest Bazikyan. "EXPERIMENTAL LOW ENERGY NANOSECOND LASEROTHERAPY AND MICROSURGERY OF MODELING PERIODONTITIS USING MORPHOLOGICAL ANALYSIS." Actual problems in dentistry 15, no. 1 (May 6, 2019): 80–86. http://dx.doi.org/10.18481/2077-7566-2019-15-1-80-86.
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Background. The problem of the treatment of periodontal disease is acute in modern dentistry. The multiplicity of etipathogenetic factors causing the development of periodontitis, malignations associated with the loss of teeth cause the search for new methods of complex therapy of periodontal diseases, including the inclusion of modern laser technologies.
Purpose ― comparative assessment of the effect on the regeneration of periodontal tissues of nanosecond laser radiation with a wavelength of 1265 ± 5 nm of traditional photodynamic therapy using morphological and morphometric analysis in an in vivo experiment.
Methodology. Modeling of periodontitis in experimental animals was performed using a ligature technique for 7 days. Treatment of periodontitis began with mechanical and drug treatment of pockets, then the animals were divided into three groups. In the first group, a new nanosecond laser device with a wavelength of 1265 ± 5 nm was used for treatment, the second used traditional photodynamic therapy using a chlorine E6 photosensitizer, in the third group until the end of treatment only drug therapy was used. On days 7, 14, 21, a visual assessment of the condition of periodontal tissues in experimental animals, morphological and morphometric analysis were performed.
Results. On the 21st day of observation in the main group in the oral cavity, the periodontal regeneration process was completed, in the comparison group there are local pockets of shallow depth with granulation tissue. The morphological study showed that in the main group the number of full blood vessels in the field of view of the microscope at the later stages of treatment is 2.9 times higher than in the comparison group.
Conclusions. The results of the study confirmed the need to include laser techniques in the complex therapy of periodontal diseases. The use of new laser technology of nanosecond laser therapy and microsurgery in the treatment of periodontal diseases contributes to shortening the procedure time, shortening the rehabilitation time, and stimulating vascular growth.
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Klein, Antonia, Sten Calvelage, Kore Schlottau, Bernd Hoffmann, Elisa Eggerbauer, Thomas Müller, and Conrad M. Freuling. "Retrospective Enhanced Bat Lyssavirus Surveillance in Germany between 2018–2020." Viruses 13, no. 8 (August 3, 2021): 1538. http://dx.doi.org/10.3390/v13081538.
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Lyssaviruses are the causative agents for rabies, a zoonotic and fatal disease. Bats are the ancestral reservoir host for lyssaviruses, and at least three different lyssaviruses have been found in bats from Germany. Across Europe, novel lyssaviruses were identified in bats recently and occasional spillover infections in other mammals and human cases highlight their public health relevance. Here, we report the results from an enhanced passive bat rabies surveillance that encompasses samples without human contact that would not be tested under routine conditions. To this end, 1236 bat brain samples obtained between 2018 and 2020 were screened for lyssaviruses via several RT-qPCR assays. European bat lyssavirus type 1 (EBLV-1) was dominant, with 15 positives exclusively found in serotine bats (Eptesicus serotinus) from northern Germany. Additionally, when an archived set of bat samples that had tested negative for rabies by the FAT were screened in the process of assay validation, four samples tested EBLV-1 positive, including two detected in Pipistrellus pipistrellus. Subsequent phylogenetic analysis of 17 full genomes assigned all except one of these viruses to the A1 cluster of the EBLV-1a sub-lineage. Furthermore, we report here another Bokeloh bat lyssavirus (BBLV) infection in a Natterer’s bat (Myotis nattereri) found in Lower Saxony, the tenth reported case of this novel bat lyssavirus.
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Chiu, Chih-Chien, Ya-Chieh Chang, Ren-Yeong Huang, Jenq-Shyong Chan, Chi-Hsiang Chung, Wu-Chien Chien, Yung-Hsi Kao, and Po-Jen Hsiao. "Investigation of the Impact of Endodontic Therapy on Survival among Dialysis Patients in Taiwan: A Nationwide Population-Based Cohort Study." International Journal of Environmental Research and Public Health 18, no. 1 (January 5, 2021): 326. http://dx.doi.org/10.3390/ijerph18010326.
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Objectives Dental problems occur widely in patients with chronic kidney disease (CKD) and may increase comorbidities. Root canal therapy (RCT) is a common procedure for advanced decayed caries with pulp inflammation and root canals. However, end-stage renal disease (ESRD) patients are considered to have a higher risk of potentially life-threatening infections after treatment and might fail to receive satisfactory dental care such as RCT. We investigated whether appropriate intervention for dental problems had a potential impact among dialysis patients. Design Men and women who began maintenance dialysis (hemodialysis or peritoneal dialysis) between January 1, 2000, and December 31, 2015, in Taiwan (total 12,454 patients) were enrolled in this study. Participants were followed up from the first reported dialysis date to the date of death or end of dialysis by December 31, 2015. Setting Data collection was conducted in Taiwan. Results A total of 2633 and 9821 patients were classified into the RCT and non-RCT groups, respectively. From the data of Taiwan’s National Health Insurance, a total of 5,092,734 teeth received RCT from 2000 to 2015. Then, a total of 12,454 patients were followed within the 16 years, and 4030 patients passed away. The results showed that members of the non-RCT group (34.93%) had a higher mortality rate than those of the RCT group (22.79%; p = 0.001). The multivariate-adjusted hazard ratio for the risk of death was 0.69 (RCT vs. non-RCT; p = 0.001). Conclusions This study suggested that patients who had received RCT had a relatively lower risk of death among dialysis patients. Infectious diseases had a significant role in mortality among dialysis patients with non-RCT. Appropriate interventions for dental problems may increase survival among dialysis patients. Abbreviations: CKD = chronic kidney disease, ESRD = end-stage renal disease, RCT = root canal therapy.
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Praus, P., F. Sureau, E. Kocisova, I. Rosenberg, J. Stepanek, and P. Y. Turpin. "A frequency Domain Phase/Modulation Technique for Intracellular Multicomponent Fluorescence Analysis: Technical Approach and Pharmacological Applications." Spectroscopy 17, no. 2-3 (2003): 429–34. http://dx.doi.org/10.1155/2003/418370.
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A UV confocal laser microspectrofluorimeter prototype has been adapted for fluorescence lifetime measurements by using a frequency-domain phase/modulation method (modulation frequency 1 to 200 MHz, lifetime resolution: tenth of a ns). This technique enables excited state lifetimes of several fluorescent components to be resolved and determined. Through a global analysis, specific spectral contribution of each species can be monitored with no need to use model spectra. This approach is efficient to distinguish strongly overlapping components (e.g., intracellular multicomponent fluorescence signal) which otherwise cannot easily be discriminated from each other. Experimental set‒up is first described. Application dealing with an antisense oligonucleotide (a synthetic dT15oligomer analogue containing isopolar, non-isosteric, phosphonate [3'-O-P-CH2-O-5'] internucleotide linkages) bound to a fluorescent label (tetramethylrhodamine dye), in various solutions and interacting with living cells, is then presented. This is of a major interest for antisense and/or antigene strategies which have recently been developed as efficient ways to cure viral and/or malignant diseases. The frequency-domain phase/modulation technique enabled oligonucleotide stability inside the cells to be checked.
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Marinkovic, Ivan. "Causes of death in Serbia since the mid-20th century." Stanovnistvo 50, no. 1 (2012): 89–106. http://dx.doi.org/10.2298/stnv1201089m.
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The structure of the leading causes of death in Serbia has considerably changed in the last half century. Diseases which presented the main threat to the population a few decades ago are now at the level of a statistical error. On the one side are causes which drastically changed their share in total mortality in this time interval, while others have shown stability and persistence among the basic causes of death. Acute infectious diseases "have been replaced" with chronic noninfectious diseases, due to the improvement of general and health conditions. One of the consequences of such changes is increased life expectancy and a larger share of older population which resulted in cardiovascular diseases and tumors to dominate more and more in total mortality. Convergent trends in the structure of the leading causes of death in Serbia from the middle of the 20th century are the reasons why there are considerably fewer diseases and causes with a significant rate in total population mortality at the beginning of the 21st century. During the 1950s, there were five groups of diseases and causes which participated individually with more than 10% of population mortality (infectious diseases, heart and circulatory diseases, respiratory diseases, some perinatal conditions and undefined states) while at the beginning of the new century there were only two such groups (cardiovascular diseases and tumors). Identical trends exist in all European countries, as well as in the rest of the developed world. The leading causes of death in Serbia are cardiovascular diseases. An average of somewhat over 57.000 people died annually in the period from 2007 - 2009, which represents 55.5% of total population mortality. Women are more numerous among the deceased and this difference is increasing due to population feminization. The most frequent cause of death in Serbia, after heart and circulatory diseases, are tumors, which caused 21,415 deaths in 2009. Neoplasms are responsible for one fifth of all deaths. Their number has doubled in three decades, from 9,107 in 1975 to about 20,000 at the beginning of the 21st century, whereby tumors have become the fastest growing cause of death. Least changes in absolute number of deaths in the last half century were marked among violent deaths. Observed by gender, men are in average three times more numerous among violent deaths than women. In the middle of the 20th century in Serbia, one third of the deaths caused by violence were younger than 25 and as many as one half were younger than 35 years old. Only one tenth (11%) of total number of violent deaths were from the age group of 65 or older. At the end of the first decade of the 21st century (2009), the share of population younger than 25 in the total number of violent deaths was decreased four times (and amounted to 8%). At the same time, the rate of those older than 65 or more quadrupled (amounted to 39%).
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Liebsch, C., V. Pitchika, C. Pink, S. Samietz, G. Kastenmüller, A. Artati, K. Suhre, et al. "The Saliva Metabolome in Association to Oral Health Status." Journal of Dental Research 98, no. 6 (April 26, 2019): 642–51. http://dx.doi.org/10.1177/0022034519842853.
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Periodontitis is one of the most prevalent oral diseases worldwide and is caused by multifactorial interactions between host and oral bacteria. Altered cellular metabolism of host and microbes releases a number of intermediary end products known as metabolites. There is an increasing interest in identifying metabolites from oral fluids such as saliva to widen the understanding of the complex pathogenesis of periodontitis. It is believed that some metabolites might serve as indicators toward early detection and screening of periodontitis and perhaps even for monitoring its prognosis in the future. Because contemporary periodontal screening methods are deficient, there is an urgent need for novel approaches in periodontal screening procedures. To this end, we associated oral parameters (clinical attachment level, periodontal probing depth, supragingival plaque, supragingival calculus, number of missing teeth, and removable denture) with a large set of salivary metabolites ( n = 284) obtained by mass spectrometry among a subsample ( n = 909) of nondiabetic participants from the Study of Health in Pomerania (SHIP-Trend-0). Linear regression analyses were performed in age-stratified groups and adjusted for potential confounders. A multifaceted image of associated metabolites ( n = 107) was revealed with considerable differences according to age groups. In the young (20 to 39 y) and middle-aged (40 to 59 y) groups, metabolites were predominantly associated with periodontal variables, whereas among the older subjects (≥60 y), tooth loss was strongly associated with metabolite levels. Metabolites associated with periodontal variables were clearly linked to tissue destruction, host defense mechanisms, and bacterial metabolism. Across all age groups, the bacterial metabolite phenylacetate was significantly associated with periodontal variables. Our results revealed alterations of the salivary metabolome in association with age and oral health status. Among our comprehensive panel of metabolites, periodontitis was significantly associated with the bacterial metabolite phenylacetate, a promising substance for further biomarker research.
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Galindo, Rodolfo J., Francisco J. Pasquel, Maya Fayfman, Katerina Tsegka, Neil Dhruv, Saumeth Cardona, Heqiong Wang, Priyathama Vellanki, and Guillermo E. Umpierrez. "Clinical characteristics and outcomes of patients with end-stage renal disease hospitalized with diabetes ketoacidosis." BMJ Open Diabetes Research & Care 8, no. 1 (February 2020): e000763. http://dx.doi.org/10.1136/bmjdrc-2019-000763.
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IntroductionThere is limited evidence to guide management in patients with end-stage renal disease (ESRD) on chronic hemodialysis admitted with diabetes ketoacidosis. Thus, we investigated the clinical characteristics and outcomes of patients with ESRD admitted with diabetic ketoacidosis (DKA).MethodsIn this observational study, we used International Classification of Diseases Ninth/Tenth Revision codes to identify adult (aged 18–80 years) patients admitted to Emory University Hospitals between 1 January 2006 and 31 December 2016. DKA and ESRD diagnoses were confirmed by reviewing medical records and by admission laboratory results.ResultsAmong 307 patients with DKA meeting the inclusion and exclusion criteria, 22.1% (n: 68) had ESRD on hemodialysis and 77.9% (n: 239) had preserved renal function (estimated glomerular filtration rate >60 mL/min/1.73 m2). Compared with patients with preserved renal function, the admission blood glucose was higher (804.5±362.6 mg/dL vs 472.5±137.7 mg/dL) and the mean hemoglobin A1c was lower (9.6%±2.1 vs 12.0%±2.5) in patients with DKA and ESRD, both p<0.001. The rates of hypoglycemia <70 mg/dL (34% vs 14%, p=0.002) and <54 mg/dL (13% vs 5%, p=0.04) were higher in the ESRD group. During hospitalization, more patients with ESRD develop volume overload (28% vs 3%, p<0.001) and require mechanical ventilation (24% vs 3%, p=<0.001). There were no differences in hospital mortality (3% vs 0%, p=0.21), but length of stay (median 7.0 vs 3.0 days, p<0.001) was longer in the ESRD cohort. After adjusting for multiple covariates, patients with DKA and ESRD have higher odds of hypoglycemia (OR 3.3, 95% CI 1.51 to 7.21, p=0.003) and volume overload (OR 4.22, 95% CI 1.37 to 13.05, p=0.01) compared with patients with DKA with preserved renal function.ConclusionsPatients with DKA and ESRD on chronic hemodialysis had worse clinical outcomes including higher rates of hypoglycemia, volume overload, need for mechanical ventilation and longer length of stay, compared with patients with preserved kidney function.
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Becerra-Culqui, Tracy A., Darios Getahun, Vicki Chiu, Lina S. Sy, and Hung Fu Tseng. "The Association of Prenatal Tetanus, Diphtheria, and Acellular Pertussis (Tdap) Vaccination With Attention-Deficit/Hyperactivity Disorder." American Journal of Epidemiology 189, no. 10 (May 7, 2020): 1163–72. http://dx.doi.org/10.1093/aje/kwaa074.
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Abstract As prenatal vaccinations become more prevalent, it is important to assess potential safety events. In a retrospective cohort study of Kaiser Permanente Southern California (Pasadena, California) mother-child pairs with birth dates during January 1, 2011–December 31, 2014, we investigated the association between prenatal tetanus, diphtheria, and acellular pertussis (Tdap) vaccination and risk of attention-deficit/hyperactivity disorder (ADHD) in offspring. Information on Tdap vaccination during pregnancy was obtained from electronic medical records. ADHD was defined by International Classification of Diseases codes (Ninth or Tenth Revision) and dispensed ADHD medication after age 3 years. Children were followed to the date of their first ADHD diagnosis, the end of Kaiser Permanente membership, or the end of follow-up (December 31, 2018). In Cox proportional hazards models, we estimated unadjusted and adjusted hazard ratios for the association between maternal Tdap vaccination and ADHD, with inverse probability of treatment weighting (IPTW) used to adjust for confounding. Of 128,756 eligible mother-child pairs, 85,607 were included in the final sample. The ADHD incidence rate was 3.41 per 1,000 person-years in the Tdap-vaccinated women and 3.93 per 1,000 person-years in the unvaccinated (hazard ratio = 1.01, 95% confidence interval: 0.88, 1.16). The IPTW-adjusted analyses showed no association between prenatal Tdap vaccination and ADHD in offspring (hazard ratio = 1.00, 95% confidence interval: 0.88, 1.14). In this study, prenatal Tdap vaccination was not associated with ADHD risk in offspring, supporting recommendations to vaccinate pregnant women.
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Walker, Tiffany A., Ben Waite, Mark G. Thompson, Colin McArthur, Conroy Wong, Michael G. Baker, Tim Wood, et al. "Risk of Severe Influenza Among Adults With Chronic Medical Conditions." Journal of Infectious Diseases 221, no. 2 (November 4, 2019): 183–90. http://dx.doi.org/10.1093/infdis/jiz570.
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Abstract Background Severe influenza illness is presumed more common in adults with chronic medical conditions (CMCs), but evidence is sparse and often combined into broad CMC categories. Methods Residents (aged 18–80 years) of Central and South Auckland hospitalized for World Health Organization-defined severe acute respiratory illness (SARI) (2012–2015) underwent influenza virus polymerase chain reaction testing. The CMC statuses for Auckland residents were modeled using hospitalization International Classification of Diseases, Tenth Revision codes, pharmaceutical claims, and laboratory results. Population-level influenza rates in adults with congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), chronic obstructive pulmonary disease (COPD), asthma, diabetes mellitus (DM), and end-stage renal disease (ESRD) were calculated by Poisson regression stratified by age and adjusted for ethnicity. Results Among 891 276 adults, 2435 influenza-associated SARI hospitalizations occurred. Rates were significantly higher in those with CMCs compared with those without the respective CMC, except for older adults with DM or those aged <65 years with CVA. The largest effects occurred with CHF (incidence rate ratio [IRR] range, 4.84–13.4 across age strata), ESRD (IRR range, 3.30–9.02), CAD (IRR range, 2.77–10.7), and COPD (IRR range, 5.89–8.78) and tapered with age. Conclusions Our findings support the increased risk of severe, laboratory-confirmed influenza disease among adults with specific CMCs compared with those without these conditions.
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Pei, Yaolin, Xi Chen, and Michele Saunders. "Socioeconomic Status, Health Behaviors, and Oral Health of Older Adults In China." Innovation in Aging 4, Supplement_1 (December 1, 2020): 832. http://dx.doi.org/10.1093/geroni/igaa057.3047.
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Abstract Many Chinese older adults suffer from oral health diseases and problems due to low oral health literacy, limited dental coverage and lack of dental care services for this segment of the population in China. However, so few studies have been conducted to examine social and behavior factors related to oral health among Chinese older adults. This symposium examines how socioeconomic status (SES) and health behaviors are associated with oral health among Chinese older adults. The first paper used the Nanjing Centenarians Study to examine the association between health behaviors and oral health among Chinese centenarians. The results showed that health behaviors were associated with self-rated oral health and edentulism. Using the Chinese Longitudinal Healthy Longevity Survey, the second one employed an ‘after death’ approach to examine risk factors for orofacial pain symptoms at the end of life among Chinese older adults. The third paper investigated the association between SES and tooth loss among middle-aged and older adults in ten cities of China. SES played a stronger role in tooth retention for non-migrants and migrants with high education vs those migrants with low education. The last paper examined the association between health behaviors and retention of teeth among Chinese older adults using data from the Chinese 4th National Oral health Survey. This symposium provides empirical evidence on the current status of oral health and health behaviors at the national level, and also suggests that is critical to improve oral health education and access to dental care.
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Runte, Christoph, and Dieter Dirksen. "Symmetry and Aesthetics in Dentistry." Symmetry 13, no. 9 (September 19, 2021): 1741. http://dx.doi.org/10.3390/sym13091741.
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Animal bodies in general and faces in particular show mirror symmetry with respect to the median-sagittal plane, with exceptions rarely occurring. Bilateral symmetry to the median sagittal plane of the body also evolved very early. From an evolutionary point of view, it should therefore have fundamental advantages, e.g., more effective locomotion and chewing abilities. On the other hand, the recognition of bilaterally symmetric patterns is an important module in our visual perception. In particular, the recognition of faces with different spatial orientations and their identification is strongly related to the recognition of bilateral symmetry. Maxillofacial surgery and Dentistry affect effective masticatory function and perceived symmetry of the lower third of the face. Both disciplines have the ability to eliminate or mitigate asymmetries with respect to form and function. In our review, we will demonstrate symmetric structures from single teeth to the whole face. We will further describe different approaches to quantify cranial, facial and dental asymmetries by using either landmarks or 3D surface models. Severe facial asymmetries are usually caused by malformations such as hemifacial hyperplasia, injury or other diseases such as Noma or head and neck cancer. This could be an important sociobiological reason for a correlation between asymmetry and perceived disfigurement. The aim of our review is to show how facial symmetry and attractiveness are related and in what way dental and facial structures and the symmetry of their shape and color influence aesthetic perception. We will further demonstrate how modern technology can be used to improve symmetry in facial prostheses and maxillofacial surgery.
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Nunes, Camilla Magnoni Moretto, Camila Lopes Ferreira, Daniella Vicensotto Bernardo, Andréa Carvalho De Marco, Mauro Pedrine Santamaria, and Maria Aparecida Neves Jardini. "Chronic kidney disease and periodontal disease. Case report." Brazilian Dental Science 21, no. 1 (March 28, 2018): 133. http://dx.doi.org/10.14295/bds.2018.v21i1.1498.
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<p>Chronic renal disease promotes a decrease on kidneys filterability and nitrogen products accumulation on blood, electrolyte and system endocrine functions imbalance. Among the many clinical manifestations of chronic renal failure (CRF) in the oral cavity, there are: dry mouth, uremic stomatitis, radiographic changes in maxillary and jaw bones and accumulation of calculus on the teeth that increases levels of periodonto pathogenic microorganisms able to lead a periodontal tissue destruction and also have the potential to act from a distance on other organs, e.g. the kidneys. Thus, it becomes evident that a periodontal treatment of patients suffering from chronic renal failure is crucial for maintaining their general health conditions and a subsequent successful organ transplant.Thus, the objectives of this case report were to highlight how important the periodontal treatment is for chronic renal failure patients and to demonstrate improvements in their clinical condition through the treatment plan proposed herein. A patient with 43 years old carrier generalized moderate chronic periodontitis and CRF was submitted to scaling and root planning sessions, and later surgical access for scaling where the basic treatment not resulted in a resolution of the inflammatory periodontal process. The results obtained from a well-developed periodontal treatment and an effective cooperation of patient showed satisfactory results with periodontal disease process resolution or stabilization.Thus, periodontal treatment and patient compliance were crucial for the improvement of periodontal clinical conditions enabling a future successful renal transplantation.</p><p><strong>Keywords</strong></p><p>Dental care; Periodontal diseases; Renal insufficiency.</p>
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Watanabe, J., K. Sakai, Y. Urata, N. Toyama, E. Nakamichi, and H. Hibi. "Extracellular Vesicles of Stem Cells to Prevent BRONJ." Journal of Dental Research 99, no. 5 (March 2, 2020): 552–60. http://dx.doi.org/10.1177/0022034520906793.
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Extracellular vesicles (EVs), several tens to hundreds of nanometers in size, are vesicles secreted by cells for intercellular communication. EVs released from mesenchymal stem cells (MSC-EVs) have the potential to treat multiple diseases. This study aimed to determine the effects of MSC-EVs on bisphosphonate-related osteonecrosis of the jaw (BRONJ), whose pathogenesis and treatment are not yet established. To this end, zoledronic acid (ZOL) was administered to bone marrow cells and fibroblasts in vitro. In vivo, a BRONJ model was produced by administering ZOL to rats and extracting teeth. Each MSC-EV-treated and nontreated group was compared histologically and molecularly. In vitro, the nontreated group showed an increased number of β-galactosidase-positive cells and expression of senescence-associated genes p21, pRB and senescence-related inflammatory cytokines. Conversely, MSC-EV administration decreased the number of senescent cells and expression levels of p21, pRB and inflammatory cytokines. In vivo, in the nontreated group, the socket was partially uncovered by the oral epithelium, leaving an exposed bone. Conversely, in the MSC-EV-treated group, the socket was healed. Besides, in the nontreated group, β-galactosidase-positive cells existed in the socket and colocalized with the CD90 and periostin-positive cells. However, there were few β-galactosidase-positive cells in the MSC-EV-treated group. Furthermore, gene expression of stem cell markers Bmi1 and Hmga2 and the vascular endothelial marker VEGF was significantly increased in the MSC-EV-treated group, compared with that in the nontreated group. These results indicate that MSC-EVs prevent ZOL-induced senescence in stem cells, osteoblasts, and fibroblasts and reduce inflammatory cytokines. Furthermore, administration of MSC-EVs prevented senescence of cells involved in wound healing and the spread of chronic inflammation around senescent cells, thereby promoting angiogenesis and bone regeneration and preventing BRONJ.
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Полушкина, Наталия Александровна, Кристина Павловна Кубышкина, Татьяна Павловна Калиниченко, Елена Юрьевна Каверина, and Марина Владимировна Воронова. "IMPROVING THE EFFECTIVENESS OF THERAPEUTIC AND PREVENTIVE MEASURES IN PATIENTS WITH CHRONIC GENERALIZED PERIODONTITIS USING A MODIFIED PERIODONTAL INDEX ACCORDING TO RUSSEL." СИСТЕМНЫЙ АНАЛИЗ И УПРАВЛЕНИЕ В БИОМЕДИЦИНСКИХ СИСТЕМАХ, no. 3() (September 30, 2020): 125–29. http://dx.doi.org/10.36622/vstu.2020.19.3.016.
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Воспалительные заболевания пародонта занимают второе место среди всех стоматологических заболеваний. Функциональные расстройства зубочелюстной системы, обусловленные потерей зубов вследствие заболеваний пародонта, развиваются в 5-6 раз чаще, чем при осложнениях кариеса, что является дополнительным основанием для того, чтобы уделять профилактике и лечению воспалительных заболеваний пародонта повышенное внимание. Заболевания пародонта трудно поддаются лечению, ведут к значительному снижению функциональных возможностей зубочелюстной системы, для них характерен длительный период реабилитации. Лечение заболеваний пародонта сопровождается участием специалистов различного профиля, является трудоемким и дорогостоящим. С этой целью для определения эффективности тех или иных лечебных мероприятий, направленных на улучшение и сохранение здоровья людей, в последние годы в различных областях медицины чаще стал использоваться такой количественный показатель, как качество жизни (КЖ). Этот показатель позволяет дать количественную оценку многокомпонентных характеристик жизнедеятельности человека - совокупность физического, психологического, эмоционального и социального функционирования, основанного на его субъективном восприятии. КЖ изменяется во времени в зависимости от состояния пациента, обусловленного рядом эндогенных и экзогенных факторов. Использование критериев КЖ в современной медицине особенно важно, т.к. позволяет выяснить комплексное отношение пациента к своему заболеванию и назначенному лечению. Данное понятие в полной мере применимо к такому разделу в медицине, как стоматология. Конечная цель стоматологической помощи заключается в достижении и поддержании у большинства людей в течение всей жизни функциональной, безболезненной, эстетичной и социально приемлемой ситуации в полости рта. Поэтому лечение заболеваний полости рта должно проводиться в достаточном объеме, чтобы достигать обозначенной цели. Такой подход позволяет объективно оценивать необходимые экономические затраты; выбирать наиболее приемлемые технологии лечения; проводить внутренний контроль работы учреждений, оказывающих стоматологическую помощь населению; учитывать мнение потребителей стоматологических услуг при планировании работы системы здравоохранения; объективно решать возникающие медико-юридические вопросы Inflammatory periodontal disease ranks second among all dental diseases. Functional disorders of the dentoalveolar system caused by the loss of teeth due to periodontal disease develop 5-6 times more often than with complications of caries, which is an additional reason to pay increased attention to the prevention and treatment of inflammatory periodontal diseases. Periodontal diseases are difficult to treat, lead to a significant decrease in the functionality of the dentoalveolar system, they are characterized by a long period of rehabilitation. Treatment of periodontal diseases is accompanied by the participation of specialists in various fields, is laborious and expensive. To this end, to determine the effectiveness of certain therapeutic measures aimed at improving and maintaining human health, in recent years in various fields of medicine such a quantitative indicator as the quality of life. Has been used more often. This indicator allows you to quantify the multicomponent characteristics of a person's vital activity - a combination of physical, psychological, emotional and social functioning based on his subjective perception. The quality of life changes over time depending on the patient's condition, due to a number of endogenous and exogenous factors. The use of QOL criteria in modern medicine is especially important because allows you to find out the complex attitude of the patient to his disease and the prescribed treatment. This concept is fully applicable to such a section in medicine as dentistry. The ultimate goal of dental care is to achieve and maintain a functional, painless, aesthetic and socially acceptable oral situation for most people throughout their lives. Therefore, the treatment of diseases of the oral cavity must be carried out in a sufficient volume to achieve the designated goal. This approach allows you to objectively assess the necessary economic costs; choose the most appropriate treatment technologies; to carry out internal control of the work of institutions providing dental care to the population; take into account the opinions of consumers of dental services when planning the work of the health care system; objectively resolve emerging medical and legal issues
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Karmarkar, Ellora, Seema Jain, Gail L. Sondermeyer Cooksey, Jennifer Myers, and Amanda Kamali. "215. Invasive Group A Streptococcus-Associated Hospitalizations and Risk Factors for In-Hospital Mortality Among Adults in California, 2000–2016." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S126—S127. http://dx.doi.org/10.1093/ofid/ofz360.290.
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Abstract Background Invasive group A Streptococcus (iGAS) causes severe illness and death but is not vaccine preventable or nationally notifiable. We describe the epidemiology of adult patients hospitalized with iGAS in California and risk factors for in-hospital death. Methods Using 2000–2016 California hospital discharge data, we extracted records for adults (≥18 years) with ≥1 group A Streptococcus (GAS)-associated International Classification of Diseases, Ninth or Tenth Revision discharge diagnosis code (e.g., unspecified GAS; GAS-specific pharyngitis, pneumonia, and sepsis) or known GAS-associated syndromes (e.g., acute rheumatic fever, erysipelas, scarlet fever). To identify patients hospitalized with iGAS, we selected extracted records that also had codes consistent with invasive disease (e.g., sepsis, pneumonia, intubation, or central line placement). We calculated iGAS-associated hospitalization incidence rates per 100,000 population and described patient demographics and comorbidities. We calculated the odds of in-hospital death using multivariable logistic regression (P < 0.05). Results During 2000–2016 in California, 37,532 adults were hospitalized with iGAS; 1,045 (3%) died in-hospital. Mean annual hospitalization incidence was 9.4/100,000 population, and was highest (16.3/100,000) in 2016 (Figure 1). Most patients were male (56%), aged 40–65 (45%) or ≥65 (28%) years, and white (60%); 18% were immunocompromised. The percent of patients who died in-hospital increased with age and was highest among those with comorbidities such as malnutrition, cardiovascular disease (CVD), and chronic kidney disease (CKD) (Figure 2). In a multivariable model including age as a continuous variable, sex, and race-ethnicity, the odds of in-hospital death was significantly increased for patients with diagnosis codes for malnutrition, liver disease, CVD, immunosuppression, and CKD (Figure 2); within the race/ethnicity variable Asian/Pacific Islander patients had a higher odds of death compared with white patients. Conclusion Hospitalization and subsequent in-hospital death due to iGAS is substantial in California. Adults with iGAS who have specific comorbidities are at greater risk for death when hospitalized with iGAS. Disclosures All authors: No reported disclosures.
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Messadi, D. V., M. D. Macek, D. Markovic, and K. A. Atchison. "Oral Health Literacy, Preventive Behavior Measures, and Chronic Medical Conditions." JDR Clinical & Translational Research 3, no. 3 (April 17, 2018): 288–301. http://dx.doi.org/10.1177/2380084418769835.
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The purpose of this study was to examine the association between oral health literacy, preventive orientation and behaviors, and chronic medical conditions—specifically, hypertension and diabetes. A cross-sectional study was conducted with dental school patients attending the dental clinics in Los Angeles, California, and Baltimore, Maryland. Their health literacy levels were measured using the short Test of Functional Health Literacy in Adults (Short-TOFHLA) and the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D). The medical history and existing medical conditions—specifically, hypertension and diabetes status—were extracted from patient health history and electronic records. Ten items were asked about preventive behaviors (e.g., brushing teeth in evening, smoking, exercise, drinking soda) and 3 preventive health services (dental checkup, flu shot, medical checkup). Six locus of control items were asked (e.g., good health is a matter of good fortune, what happens to my health is God’s will). Out of 793 subjects, 221 had a documented history of hypertension, 88 with diabetes. There was an association between Short-TOFHLA scores and both diabetes and hypertension, but after controlling for sociodemographic and preventive variables, the association was no longer significant. In multivariate analysis, women, people with at least some college, Asians or non-Hispanic Whites, younger people, those who spoke English as a child, those who sought health information from the Internet or health care professionals, and those who smoked reported lower utilization of preventive health services, and those who had less locus of control reported higher Short-TOFHLA scores. There were no significant differences in mean REALM-D scores between patients who had hypertension or diabetes versus not having the condition. Multivariate models showed that people with higher REALM-D scores had at least some college, were other race/ethnicity or non-Hispanic White, spoke English as a child, and sought health information via the Internet. Knowledge Transfer Statement: The results of this study show that dental school patients exhibit a range of health literacy abilities and preventive behaviors, and health literacy measures positively correlated with some preventive behaviors but not others. Dental schools receive a significant number of patients with chronic diseases, and students should be educated to use effective patient communication skills to reinforce positive health behaviors among these patients.
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Fretheim, Håvard, Anne-Kristine Halse, Marit Seip, Helle Bitter, Marianne Wallenius, Torhild Garen, Anne Salberg, et al. "Multidimensional tracking of phenotypes and organ involvement in a complete nationwide systemic sclerosis cohort." Rheumatology 59, no. 10 (February 25, 2020): 2920–29. http://dx.doi.org/10.1093/rheumatology/keaa026.
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Abstract Objective SSc is a severe, heterogeneous multi-organ disease where population-based estimates on phenotypic spectrum, overall disease burden and societal impact are largely missing. Here the objective was to provide the first-ever complete national-level data on phenotype and major organ afflictions in SSc. Methods A stepwise strategy was applied to find and characterize every SSc patient resident in Norway from 2000 to 2012. First we identified every case in the country registered with an International Classification of Diseases, Tenth Revision code for SSc (M34). Next we manually reviewed all cases coded as M34 to determine whether they met the 1980 ACR and/or 2013 ACR/EULAR classification criteria for SSc and could be included in the Norwegian SSc cohort (Nor-SSc). Finally, all disease features from SSc onset to study end were reviewed. Results The Nor-SSc cohort included 815 SSc patients. The mean age at diagnosis was 53 years, with 84% females and 77% limited cutaneous SSc. The estimated incidence increased from 4 per million in 2000 to 13 per million in 2012. We identified high cumulative frequencies of internal organ involvement, coexistence of multiple organ afflictions across disease subsets and autoantibody status and stable frequencies of pulmonary arterial hypertension across haemodynamic definitions, but indications of referral-related differences in pulmonary hypertension detection rates across the study area. Conclusion This nationwide cohort study provides new, unbiased evidence for a high disease burden in SSc patients of Caucasian descent and indicates the existence of hurdles preventing equality of assessment across the SSc population.
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Stańdo, Mirella, Paweł Piatek, Magdalena Namiecinska, Przemysław Lewkowicz, and Natalia Lewkowicz. "Omega-3 Polyunsaturated Fatty Acids EPA and DHA as an Adjunct to Non-Surgical Treatment of Periodontitis: A Randomized Clinical Trial." Nutrients 12, no. 9 (August 27, 2020): 2614. http://dx.doi.org/10.3390/nu12092614.
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Periodontitis is a chronic multifactorial inflammatory disease that leads to the loss of supportive tissues around the teeth with gradual deterioration of masticatory function and esthetics, resulting eventually in the decrease of the life quality. Host immune response triggered by bacterial biofilm is responsible for the chronic periodontal inflammation and ongoing tissue loss. Omega-3 polyunsaturated fatty acids (PUFA) such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have anti-inflammatory properties, thus may be used for the treatment of chronic inflammatory diseases. In this study, we aimed to evaluate the effect of dietary supplementation with omega-3 PUFA in the patients with stage III and IV periodontitis. Thirty otherwise healthy patients were treated with scaling and root planning (SRP). In the test group (n = 16), patients were additionally supplemented with 2.6 g of EPA and 1.8 g of DHA. In the control group (n = 14), patients received only SRP. Periodontal examination was performed at baseline and three months following initial therapy. Salivary samples were taken twice at baseline and at the end of the experiment. We found that there was a statistically significant reduction in the bleeding on probing (BOP) and improvement of clinical attachment loss (CAL) at three months in the test group compared to the control group. Moreover, a statistically significant higher percentage of closed pockets (probing depth ≤ 4 mm without BOP) was achieved in the test group vs. control group after three months of treatment. Accordingly, the levels of pro-inflammatory cytokines/chemokines interleukin (IL)-8 and IL-17 were markedly lower, while the level of anti-inflammatory IL-10 was significantly higher in the salivary samples of the patients supplemented with omega-3 PUFA at three months in comparison to the patients treated with SRP alone. Our findings demonstrate that dietary intervention with high-dose of omega-3 PUFA during non-surgical therapy may have potential benefits in the management of periodontitis.
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Stack, Austin G., Michelle Elizabeth Johnson, Betina Blak, Alyssa Klein, Lewis Carpenter, Robert Morlock, Andrew R. Maguire, and Victoria L. Parsons. "Gout and the risk of advanced chronic kidney disease in the UK health system: a national cohort study." BMJ Open 9, no. 8 (August 2019): e031550. http://dx.doi.org/10.1136/bmjopen-2019-031550.
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ObjectiveEvaluate the association between gout and risk of advanced chronic kidney disease (CKD).DesignRetrospective matched cohort study.SettingUK Clinical Practice Research Datalink.ParticipantsThe analysis included data for 68 897 patients with gout and 554 964 matched patients without gout. Patients were aged ≥18 years, registered at UK practices, had ≥12 months of clinical data and had data linked with Hospital Episode Statistics. Patients were excluded for history of advanced CKD, juvenile gout, cancer, HIV, tumour lysis syndrome, Lesch-Nyhan syndrome or familial Mediterranean fever.Primary and secondary outcome measuresAdvanced CKD was defined as first occurrence of: (1) dialysis, kidney transplant, diagnosis of end-stage kidney disease (ESKD) or stage 5 CKD (diagnostic codes in Read system or International Classification of Diseases, Tenth Revision); (2) estimated glomerular filtration rate (eGFR) <10 mL/min/1.73 m²; (3) doubling of serum creatinine from baseline and (4) death associated with CKD.ResultsAdvanced CKD incidence was higher for patients with gout (8.54 per 1000 patient-years; 95% CI 8.26 to 8.83) versus without gout (4.08; 95% CI 4.00 to 4.16). Gout was associated with higher advanced CKD risk in both unadjusted analysis (HR, 2.00; 95% CI 1.92 to 2.07) and after adjustment (HR, 1.29; 95% CI 1.23 to 1.35). Association was strongest for ESKD (HR, 2.13; 95% CI 1.73 to 2.61) and was present for eGFR <10 mL/min/1.73 m² (HR, 1.45; 95% CI 1.30 to 1.61) and serum creatinine doubling (HR, 1.13; 95% CI 1.08 to 1.19) but not CKD-associated death (HR, 1.14; 95% CI 0.99 to 1.31). Association of gout with advanced CKD was replicated in propensity-score matched analysis (HR, 1.23; 95% CI 1.17 to 1.29) and analysis limited to patients with incident gout (HR, 1.28; 95% CI 1.22 to 1.35).ConclusionsGout is associated with elevated risk of CKD progression. Future studies should investigate whether controlling gout is protective and reduces CKD risk.
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Bugge, Christoffer, Stein Kaasa, Erik Magnus Sæther, Hans Olav Melberg, and Ivar Sonbo Kristiansen. "What are determinants of utilisation of pharmaceutical anticancer treatment during the last year of life in Norway? A retrospective registry study." BMJ Open 11, no. 9 (September 2021): e050564. http://dx.doi.org/10.1136/bmjopen-2021-050564.
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ObjectivesThe objective of this study was to investigate the use of, and predictors for, pharmaceutical anticancer treatment (PACT) towards the end of a patient’s life in a country with a public healthcare system.DesignRetrospective registry study.SettingSecondary care in Norway.ParticipantsAll Norwegian patients with cancer (International Classification of Diseases tenth revision (ICD-10) codes C00–99, D00–09, D37–48) in contact with a somatic hospital in Norway between 2009 and 2017 (N=420 655). Analyses were performed on a subsample of decedents with follow-back time of more than 1 year (2013–2017, N=52 496).InterventionsN/A.Primary and secondary outcome measuresProportion of patients receiving PACT during the last year and month of life. We calculated CIs with block bootstrapping, while predictors of PACT were estimated with logistic regression.Results24.0% (95% CI 23.4% to 24.6%) of the patients received PACT during the last year of life and 3.2% (95% CI 3.0% to 3.5%) during their final month. The proportion during the last month was highest for multiple myeloma (12.7%) and breast cancer (6.5%) and lowest for urinary tract (1.1%) and prostate and kidney cancer (1.4%). Patients living in northern (OR 0.80, 95% CI 0.68 to 0.94) and western (OR 0.85, 95% CI 0.75 to 0.96) Norway had lower odds of PACT during the last month, while patients with myeloma (OR 3.0, 95% CI 2.5 to 3.7) and breast (OR 1.4, 95% CI 1.1 to 1.6) had higher odds. Kidney cancer (OR 0.25, 95% CI 0.2. to 0.4), urinary tract (OR 0.38, 95% CI 0.3 to 0.5) and prostate cancer (OR 0.4, 95% CI 0.3 to 0.5) were associated with lower probability of receiving PACT within the last month.ConclusionsThe proportion of patients receiving PACT in Norway is lower than in several other industrialised countries. Age, type of cancer and area of living are significant determinants of variation in PACT.
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Chyrchel, Bolt, Długosz, Urbańska, Nowak-Kępczyk, Bałata, Rożanowska, Czestkowska, Kruszelnicka, and Surdacki. "Better Myocardial Function in Aortic Stenosis with Low Left Ventricular Mass: A Mechanism of Protection against Heart Failure Regardless of Stenosis Severity?" Journal of Clinical Medicine 8, no. 11 (November 1, 2019): 1836. http://dx.doi.org/10.3390/jcm8111836.
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About one-tenth to one-third of patients with severe aortic stenosis (AS) do not develop left ventricular hypertrophy (LVH). Intriguingly, the absence of LVH despite severe AS is associated with lower prevalence of heart failure (HF), which challenges the classical notion of LVH as a beneficial compensatory response. Notably, the few studies that have attempted to characterize AS subjects with inadequately low left ventricular (LV) mass relative to LV afterload (i-lowLVM) described better prognosis and enhanced LV performance in AS associated with i-lowLVM, but those reports were limited to severe AS. Our aim was to compare myocardial function between moderate and severe AS with i-lowLVM. We retrospectively analyzed in-hospital records of 225 clinically stable nondiabetic patients with isolated moderate or severe degenerative AS in sinus rhythm, free of coexistent diseases. Subjects with i-lowLVM were compared to those with appropriate or excessive LVM (a/e-LVM), defined on the basis of the ratio of a measured LVM to the LVM predicted from an individual hemodynamic load. Patients with i-lowLVM and a/e-LVM did not differ in aortic valve area, LV end-diastolic diameter (LVd, a measure of LV preload), and circumferential end-systolic LV wall stress (cESS), an estimate of LV afterload. Compared to a/e-LVM, patients with i-lowLVM had increased LV ejection fraction (EF) and especially higher LV midwall fractional shortening (a better index of LV myocardial function than EF in concentric LV geometry) (p < 0.001–0.01), in both moderate and severe AS. LVd and cESS were similar in the four subgroups of the study subjects, i.e., moderate AS with i-lowLVM, moderate AS with a/e-LVM, severe AS with i-lowLVM, and severe AS with a/e-LVM (p > 0.6). Among patients with i-lowLVM, LVM did not differ significantly between moderate and severe AS (p > 0.4), while in those with a/e-LVM, LVM was increased in severe versus moderate AS (p < 0.001). In conclusion, the association of the low-LVM phenotype with better myocardial contractility may already develop in moderate AS. Additionally, cESS appears to be a controlled variable, which is kept constant over AS progression irrespective of LVM category, but even when controlled (by increasing LVM), is not able to prevent deterioration of LV function. Whether improved myocardial performance contributes to favorable prognosis and the preventive effect against HF in AS without LVH, remains to be studied.
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Poshekhonova, O. E., D. I. Razhev, S. M. Slepchenko, Z. V. Marchenko, and V. N. Adaev. "DIETARY STRATEGIES OF NORTHERN SELKUPS IN THE 18th–19th CENTURIES." VESTNIK ARHEOLOGII, ANTROPOLOGII I ETNOGRAFII, no. 4(47) (December 30, 2019): 121–39. http://dx.doi.org/10.20874/2071-0437-2019-47-4-10.
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The article considers the dietary habits of a small Selkup group that lived in the north of Western Siberia along the upper reaches of the Taz River in the18th–19th centuries. To this end, we carried out paleopathological and archaeoparasitological studies of the anthropological material from a burial ground located next to the once-existing settlement of Karakonskaya, as well as performed an isotopic analysis of organic samples. Another ob-jective was to study archival documents containing information on the inhabitants of the Upper Taz area. The isotope analysis included 17 anthropological and zooarchaeological samples, represented by the bones, hair and nails of 10 people, bones of a herbivore (reindeer), an omnivore (squirrel) (2) and fish (3). Soil samples taken from the surface of the sacra of 22 people served as the material for the archaeoparasitological study. Paleopa-thological studies included the bone remains of 23 people. We examined the originals of 19th-century documents stored at the State Archives of the Krasnoyarsk Territory. In order to differentiate the sources of land- and river-based diet, we analysed the stable-isotope ratio of carbon (δ13C) and nitrogen (δ15N) in anthropological and zooarchaeological samples. The comparison of collagen and keratin isotopic values in one individual allowed seasonal variations in the diet to be established. For the purpose of identifying gender differences in the diet, an isotopic comparison between men and women was performed. In order to characterise the ways of food con-sumption and preparation, soil samples taken from burials were studied to detect eggs of intestinal parasites, as well as to establish their species. Other aspects of the group’s diet were studied by analysing the manifestations of porotic hyperostosis on the skull and dental diseases. When working on the archival materials, we employed cross-validation of information and analysed some documents covering large time intervals. It was established that the everyday diet the local Selkup group included bottom-dwelling and predatory fish, whereas the consump-tion of land mammals was minimal. Moreover, when preparing fish dishes for all members of the group, including children, fish was not heated or it was not heated enough. Seasonal fluctuations in the diet associated with hunt-ing certain animals were recorded. The consumption of sugar and flour-based food by the Northern Selkups until the beginning of the 20th century was insignificant. Regular periods of hunger occurred given that the population had no tradition to make long-term food reserves. The consumption of certain food (dishes) resulted in the da-mage to the teeth and soft tissues of the mouth. For the men of this group, hunted food was somewhat more ac-cessible than for women. The dietary system of the Northern Selkups had more in common with their closest neighbours — the Khanty of the Vakh River — rather than with the ethnically close Southern Selkups.
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Tabah, Ashley, David Huggar, Krystal Huey, Ronda Copher, Zheng-Yi Zhou, Miriam L. Zichlin, Sarah H. Koenigsberg, and Andrew M. Brunner. "Economic Burden of Newly Diagnosed Acute Myeloid Leukemia: A Retrospective Study Using the SEER-Medicare Database." Blood 136, Supplement 1 (November 5, 2020): 45. http://dx.doi.org/10.1182/blood-2020-136768.
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Introduction: Acute myeloid leukemia (AML) poses significant economic burden on the healthcare system, particularly during induction therapy and at disease relapse. The burden associated with ongoing post-remission therapy is less clear. In patients diagnosed with AML enrolled in Medicare who received an induction therapy and achieved disease remission, we assessed the healthcare resource utilization (HCRU) and costs associated with each disease period (induction, early/late post-remission, and post-relapse). Methods: A retrospective analysis was conducted using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, comprising Medicare claims (parts A, B, and D from 2007 to 2016) and the US National Cancer Institute's SEER database (cancer diagnoses from 2007 to 2015). Identified patients had a diagnosis of AML in the SEER registry, were ≥ 65 years at the AML diagnosis date, initiated chemotherapy post-AML diagnosis (i.e. induction), and had an International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis code for AML remission following the start of therapy. Patients were excluded if they had another blood malignancy, had received a prior hematopoietic stem cell transplant, or were enrolled in a clinical trial. Induction was defined as any therapy received from the date of first post-diagnosis chemotherapy initiation (index date) to the end of the cycle during which a patient had an ICD-9/10 code for AML remission. The 6 months prior to the index date was defined as the baseline period. Post-remission therapy was divided into an early post-remission period, which included any therapy initiated within the first 60 days (≤ 60 d) after end of induction, and a late post-remission period, which included therapy initiated more than 60 days (> 60 d) after end of induction. If specific treatment information was available, late post-remission therapy was defined by a treatment switch occurring > 60 d after end of induction. Post-remission therapy ended at the earliest of relapse or end of follow-up (i.e., death, end of eligibility, or end of available data [December 31, 2016]). The post-relapse period was from the date of first AML relapse ICD-9/10 code after remission to the end of follow-up. Baseline patient characteristics, as well as HCRU and costs (adjusted to 2019 US dollars) during the baseline, induction, post-remission, and post-relapse periods, were summarized descriptively. HCRU and costs associated with induction and post-remission therapy periods were assessed during days that were part of a treatment cycle. The average per patient per month (PPPM) HCRU and costs were reported. Duration of response (DoR) from the first remission to the earliest of relapse or death was estimated using Kaplan-Meier analysis. Results: A total of 530 patients were identified. The median age at AML diagnosis was 73 years, 53.6% of patients were male, and 80.6% were white. The median time from index date to the end of follow-up was 13.5 months. Most patients received therapy with hypomethylating agents during the AML treatment. A total of 31.9% of patients who achieved remission did not receive post-remission therapy during follow-up; for these patients, mean (median) time from end of induction to relapse or end of follow-up was 125 (23) days. A total of 63.2% of patients received chemotherapy in the early post-remission period, and 43.0% of all patients went on to receive chemotherapy in the late post-remission period. The median DoR was 5.8 months; a total of 48.9% of patients had relapsed and 80.2% had died by the end of follow-up. The mean PPPM healthcare costs were highest for induction, followed by post-relapse, early post-remission, and late post-remission periods (Table). Costs associated with the inpatient (IP) setting were the greatest contributor to PPPM costs across all periods. IP visits were most common during induction with 92.1% of patients having ≥ 1 IP visit, relative to 53.8% during baseline, 65.7% during early post-remission, 71.5% during late post-remission, and 91.1% post-relapse. Conclusions: The economic burden of relapse is approximately 1.2 and 1.6 times higher than the mean PPPM healthcare costs during early and late post-remission periods, respectively. There exists a large unmet need for therapies that will extend the duration of the post-remission period and reduce the overall economic burden of AML. Disclosures Tabah: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Huggar:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company; Karyopharm Therapeutics: Current equity holder in publicly-traded company; FibroGen: Current equity holder in publicly-traded company. Huey:Bristol Myers Squibb: Current Employment. Copher:Bristol Myers Squibb: Current Employment. Zhou:BMS: Other: Employee of Analysis Group Inc., which received consulting fees. Zichlin:BMS: Other: Employee of Analysis Group Inc., which received consulting fees. Koenigsberg:BMS: Other: Employee of Analysis Group Inc., which received consulting fees. Brunner:Novartis: Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Research Funding; AstraZeneca: Research Funding; Forty-Seven Inc: Membership on an entity's Board of Directors or advisory committees; Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees.
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Dantuluri, K., J. Bruce, K. Edwards, L. Howard, and C. Grijalva. "#41: Examining the Role of Rurality on the Incidence of Acute Respiratory Illnesses, Overall Antibiotic Use and Inappropriate Antibiotic Use Among Young Children in Tennessee." Journal of the Pediatric Infectious Diseases Society 10, Supplement_1 (March 1, 2021): S12—S13. http://dx.doi.org/10.1093/jpids/piaa170.035.
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Abstract Background The Centers for Disease Control and Prevention (CDC) defines inappropriate antibiotic use as prescribing antibiotics not in accordance with national and local evidence-based guidelines, wrong selection of antibiotics, wrong dosing of antibiotics, or wrong duration of antibiotic use. Inappropriate antibiotic use has been associated with the development and transmission of antibiotic-resistant organisms. Acute respiratory illnesses (ARI) are the leading causes of antibiotic use among children with rates of antibiotic use in Tennessee children among the highest in the United States. The reasons for this have not been adequately assessed, particularly in children enrolled in the Tennessee Medicaid (TennCare) program, who tend to live in low-income households and rural locales and are disproportionately underrepresented in database studies conducted in large managed care organizations. We sought to examine whether the rates of ARI-related overall antibiotic use and inappropriate antibiotic use among young children enrolled in TennCare vary by the rurality of their county of residence. Methods This was a retrospective cohort study of children aged 2 months–5 years enrolled in TennCare from July 1, 2007, to June 30, 2017. We used pharmacy and healthcare claims data to calculate the incidence of ARI and ARI-related antibiotic use. Each eligible child entered into the cohort at the earliest time when selection criteria were met, and follow-up continued from cohort entry until the earliest of loss of enrollment, death, end of study, or meeting exclusion criteria. ARI was identified using International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10) and ARI-related antibiotic use was defined as an antibiotic prescription filled within 72 hours of an ARI. ARI-related antibiotic use was classified as potentially appropriate or inappropriate using a previously published CDC classification system. The rurality of children’s county of residence was defined as either mostly urban, mostly rural, or completely rural based upon the United States Census Bureau definitions. We calculated incidence rates for ARI, ARI-related antibiotic use, and ARI-related inappropriate antibiotic use. To assess the effect of rurality of residence on these outcomes, we used multivariable mixed-effects Poisson regression. These analyses accounted for other factors including child age, gender, race, underlying comorbidities, calendar year and month, and history of antibiotic exposure. Results In total, 813,432 children met enrollment criteria and contributed a total of 2,057,272 person-years for the cohort. Overall, the rate of ARIs, antibiotic use associated with ARIs, and inappropriate antibiotic use associated with ARIs has trended down over time (Figure 1A). There were higher rates of these three outcomes in children who live in mostly rural and completely rural counties compared with those who live in mostly urban counties (Figure 1B–D). Conclusions Children who live in rural counties in Tennessee are disproportionately affected by higher rates of ARIs, antibiotic use, and inappropriate antibiotic use compared with those who live in urban counties. These findings can inform targeted stewardship interventions to reduce inappropriate antibiotic prescribing and to decrease the rates of antibiotic-resistant infections.
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Morrison, Anthony P., Melissa Pyle, Andrew Gumley, Matthias Schwannauer, Douglas Turkington, Graeme MacLennan, John Norrie, et al. "Cognitive–behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT." Health Technology Assessment 23, no. 7 (February 2019): 1–144. http://dx.doi.org/10.3310/hta23070.
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BackgroundClozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of cognitive–behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome.DesignThe Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU).SettingSecondary care mental health services in five cities in the UK.ParticipantsPeople with CRS aged ≥ 16 years, with anInternational Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms.InterventionsIndividual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services.Main outcome measuresThe primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs.ResultsParticipants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) –3.32 to 1.55 points;p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (–2.40 points, 95% CI –4.79 to –0.02 points;p = 0.049). CBT was associated with a net cost of £5378 (95% CI –£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46;p = 0.58).ConclusionsCognitive–behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained.Trial registrationCurrent Controlled Trials ISRCTN99672552.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.
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Brennan, Alan, Colin Angus, Robert Pryce, Penny Buykx, Madeleine Henney, Duncan Gillespie, John Holmes, and Petra S. Meier. "Potential effects of minimum unit pricing at local authority level on alcohol-attributed harms in North West and North East England: a modelling study." Public Health Research 9, no. 4 (March 2021): 1–106. http://dx.doi.org/10.3310/phr09040.
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Background In 2018, Scotland implemented a 50p-per-unit minimum unit price for alcohol. Previous modelling estimated the impact of minimum unit pricing for England, Scotland, Wales and Northern Ireland. Decision-makers want to know the potential effects of minimum unit pricing for local authorities in England; the premise of this study is that estimated effects of minimum unit pricing would vary by locality. Objective The objective was to estimate the potential effects on mortality, hospitalisations and crime of the implementation of minimum unit pricing for alcohol at local authority level in England. Design This was an evidence synthesis, and used computer modelling using the Sheffield Alcohol Policy Model (local authority version 4.0). This study gathered evidence on local consumption of alcohol from the Health Survey for England, and gathered data on local prices paid from the Living Costs and Food Survey and from market research companies’ actual sales data. These data were linked with local harms in terms of both alcohol-attributable mortality (from the Office for National Statistics) and alcohol-attributable hospitalisations (from Hospital Episode Statistics) for 45 conditions defined by the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. These data were examined for eight age–sex groups split by five Index of Multiple Deprivation quintiles. Alcohol-attributable crime data (Office for National Statistics police-recorded crimes and uplifts for unrecorded offences) were also analysed. Setting This study was set in 23 upper-tier local authorities in North West England, 12 upper-tier local authorities in the North East region and nine government office regions, and a national summary was conducted. Participants The participants were the population of England aged ≥ 18 years. Intervention The intervention was setting a local minimum unit price. The base case is 50p per unit of alcohol. Sensitivity analyses were undertaken using minimum unit prices of 30p, 40p, 60p and 70p per unit of alcohol. Main outcome measures The main outcome measures were changes in alcohol-attributable deaths, hospitalisations and crime. Savings in NHS costs, changes in alcohol purchasing and consumption, changes in revenue to off-trade and on-trade retailers and changes in the slope index of inequality between most and least deprived areas were also examined. Results The modelling has proved feasible at the upper-tier local authority level. The resulting estimates suggest that minimum unit pricing for alcohol at local authority level could be effective in reducing alcohol-attributable deaths, hospitalisations, NHS costs and crime. A 50p minimum unit price for alcohol at local authority level is estimated to reduce annual alcohol-related deaths in the North West region by 205, hospitalisations by 5956 (–5.5%) and crimes by 8528 (–2.5%). These estimated reductions are mostly due to the 5% of people drinking at high-risk levels (e.g. men drinking > 25 pints of beer or five bottles of wine per week, women drinking > 17 pints of beer or 3.5 bottles of wine per week, and who spend around £2500 per year currently on alcohol). Model estimates of impact are bigger in the North West and North East regions than nationally because, currently, more cheap alcohol is consumed in these regions and because there are more alcohol-related deaths and hospitalisations in these areas. A 30p minimum unit price has estimated effects that are ≈ 90% lower than those of a 50p minimum unit price, and a 40p minimum unit price has estimated effects that are ≈ 50% lower. Health inequalities are estimated to reduce with greater health gains in the deprived areas, where more cheap alcohol is purchased and where there are higher baseline harms. Limitations The approach requires synthesis of evidence from multiple sources on alcohol consumption; prices paid; and incidence of diseases, mortality and crime. Price elasticities used are from previous UK analysis of price responsiveness rather than specific to local areas. The study has not estimated ‘cross-border effects’, namely travelling to shops outside the region. Conclusions The modelling estimates suggest that minimum unit pricing for alcohol at local authority level would be an effective and well-targeted policy, reducing inequalities. Future work The Sheffield Alcohol Policy Model for Local Authorities framework could be further utilised to examine the local impact of national policies (e.g. tax changes) or local policies (e.g. licensing or identification and brief advice). As evidence emerges from the Scottish minimum unit price implementation, this will further inform estimates of impact in English localities. The methods used to estimate drinking and purchasing patterns in each local authority could also be used for other topics involving unhealthy products affecting public health, for example to estimate local smoking or high-fat, high-salt food consumption patterns. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 4. See the NIHR Journals Library website for further project information.
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Cogle, Christopher R., Ashley Cole, Iman Imanirad, Leena Kamat, Daohai Yu, Alan F. List, and Dana E. Rollison. "A Keyword Search Strategy to Identify Missed Cases of Myelodysplastic Syndromes in Population-Based Cancer Registries." Blood 114, no. 22 (November 20, 2009): 4852. http://dx.doi.org/10.1182/blood.v114.22.4852.4852.
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Abstract Abstract 4852 BACKGROUND Myelodysplastic syndromes (MDS) were reclassified from blood disorders to neoplasms in the tenth edition of the International Classification of Diseases and, as a result, became reportable malignancies to population-based cancer registries in 2001. Recent analyses of data from the North American Association of Central Cancer Registries (NAACCR), which includes registries reporting to the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, provided the first opportunity to investigate the incidence and survival of patients with myelodysplastic syndromes (MDS) in the U.S. However, several lines of evidence suggest that reported MDS incidence rates are considerably underestimated (Rollison, Blood 2008). Due to the unique patterns in diagnosis and treatment of MDS, many MDS patients may not access hospital-based care, particularly during the early stages of their disease. These cases are potentially missed by population-based cancer registries if they are not routinely reported to such registries by their private physicians. Given the potential for under-reporting, it was hypothesized that the true incidence of MDS is higher than currently estimated by population-based cancer registries and that previously missed MDS cases could be identified through careful systematic review of electronic pathology reports obtained from private laboratories. To test this hypothesis, a feasibility pilot study was initiated in collaboration with the Florida Cancer Data System (FCDS), the statewide cancer registry, which uses electronic pathology (E-Path) reporting. METHODS All E-Path reports sent by private pathology laboratories to FCDS in 2006 were queried using MDS keyword terms, including words and phrases potentially representative of MDS (e.g., myelodysplastic, ringed sideroblast, Pelger-Huet, etc.). E-path reports that matched one or more of the search terms were compared to the FCDS database to distinguish E-path reports that corresponded to individuals already in the FCDS database from those that corresponded to individuals who were not in the FCDS database. For those individuals within the FCDS database that linked to one or more E-path reports, demographic characteristics were compared between those with a previous MDS diagnosis recorded in MDS and those with one or more diagnoses of cancers other than MDS. Within the latter group, E-path reports were categorized by number of keyword hits, and a random sample of 50 E-path reports from each category were reviewed by a single hematologist/oncologist (CRC) to confirm the diagnosis of MDS. The percentage of missed cases was calculated as the number of E-path reports that were determined to be MDS divided by the number of E-path reports reviewed. RESULTS The initial query captured 121,279 E-path reports. After excluding 40,894 duplicate records, 80,385 unique E-path reports were identified, of which 19,812 linked to a cancer patient registered in FCDS. Of those 19,812 E-path reports, 1,452 (7%) linked to patients for whom a diagnosis of MDS was recorded in FCDS, and 18,357 linked to patients with cancer diagnoses other than MDS. The probability of an E-path report linking to an MDS case increased with the number of keyword hits in the E-path report (p <0.0001). As compared to FCDS-registered patients with cancers other than MDS who linked to an E-path report matching at least one MDS keyword, those registered with MDS were older (p<0.0001) and more likely to be male (p = 0.0002). Based on the review of 200 randomly selected cases, the overall percentage of missed MDS cases was 3.5%, with the percentage increasing with number of keyword hits. For reports deemed non-MDS by the cancer registry yet matching 6+ MDS keywords, at least 14% were missed cases of MDS. CONCLUSION This pilot study demonstrated the potential for MDS cases to be missed, even when the patients are already registered as having another type of cancer in population-based cancer registries. Application of a keyword search strategy to identify missed cases of MDS among electronic pathology reports is a feasible technique for improving case ascertainment of MDS in population-based cancer registries. Given the existence of missed MDS cases, it is likely that MDS incidence rates are underestimated at the population level. Disclosures No relevant conflicts of interest to declare.
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Cilliers, Louise, and François Retief. "Orthopedics in the Graeco - Roman era." Suid-Afrikaanse Tydskrif vir Natuurwetenskap en Tegnologie 28, no. 2 (September 6, 2009): 87–100. http://dx.doi.org/10.4102/satnt.v28i2.63.
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In this study the evolutionary development of orthopedics (management of diseases of bones and joints), which commenced in early Mesopotamia and Egypt, is followed through Classical times.The Greek infl uence probably commenced in the 6thcentury BC with Democedes of Croton who cured the Persian king’s dislocated ankle. The Corpus Hippocraticum laid the foundation of orthopedic practice in antiquity. Although knowledge of anatomy was limited, its four books on orthopedics (The Nature of Bones, Mochlicon, On Fractures, On Joints) count amongst the outstanding contributions of Hippocratic writers. In systematic manner the general recognition and management of fractures and dislocations are covered, followed by the handling of individual lesions. Hippocrates differentiated between closed and open fractures (with overlaying skin wounds). Closed fractures were reduced to as normal a position as possible – manually where possible, but with large bones and in the presence of formidable muscle mass, mechanical traction was often employed (e.g. the Hippocratic bench and the bizarre succusion ladder for spinal deformities). There is no mention of the use of analgetic drugs. After application of cerate (mixture of olive oil, soda and pitch) to the skin, the fracture was immobilized by a combination of plasters and compresses (often fi rmed up with gum-mixtures) – but never very fi rmly. On the 3rd, 6/7th, 9thand 12th days the bandaging was removed, the lesion inspected and if considered necessary, re-aligned, A variety of splints were then applied. Strict bed rest was enforced, as well as a light diet (no wine or meat for 10 days). It was believed that fractures of the feet, clavicle, ribs and jaw healed after 20 days, of the forearm after 30 days, and fractures of the upper arm and leg after 40 days. Open fractures were considered very serious injuries, and reduced very carefully. Protruding bone fragments were removed (sawn off if necessary) and the wound was covered with black cerate, compresses and light bandages. Pressure and heavy splints were thought to induce infection and gangrene and thus avoided. Dislocations were reduced as soon and as effectively as possible, before muscle spasm set in. As with fractures manual reduction was, where necessary, complemented by mechanical traction. After extensive washing of the joint area with warm water, cerate was applied to the wound and specialised bandaging (even splints) ensured immobilization. Open dislocations like open fractures were considered very serious and reduction was not attempted. Again all pressure bandaging was avoided. A non-functional joint was commonly the end result. The management of 18 specifi c fractures is described in detail. Jaw fractures were fi xed by the binding of contiguous teeth. Fractures of the spinal column clearly presented a major problem. Although knowledge of spinal anatomy was surprisingly good, the diagnosis of fractures was very difficult and its association with spinal curvatures presented almost insurmountable problems of management. It was recognized that rib fractures could cause serious damage to the lung and pleura. Complex problems caused by arm fractures involving the elbow or shoulder joints, and combined radius and ulna fractures, are addressed. Femur fractures presented major problems and permanent leg deformity was very common. Open femur fractures were extremely serious and Hippocrates even stated that a physician who could ethically avoid becoming involved in treating such an injury, should do so. Fractures of femur necks were not recognised. The Hippocratic work, Wounds of the head, dealing with fractures of the skull, is not covered in this study.Management of the major joints are individually described. Seven different techniques of reducing a dislocated shoulder joint are mentioned The original description of the management of the dislocation of the wrist and hand is lost. Proper reduction of hip-dislocation was essential to avoid muscle atrophy and life-long limping, and was achieved by intricate mechanical suspension. Strangely enough, lateral dislocation of the knee was a common occurrence and not seen as a serious problem. Congenital club feet were effectively treated by prolonged fi xation in the correct position by way of tight bandaging with compresses stiffened in glue-mixtures.There is abundant skeletal evidence of osteo-arthritis in Neolithic man, but no clear description of it in the Corpus Hippocraticum. Gout is repeatedly mentioned in the Corpus but without detailed descriptions of the disease. In the Roman era authors like Heliodorus, Antyllus and Celsus in particular, wrote authoritatively on orthopedic subjects, Osteo-archaeological evidence is that fractures were treated expertly in the Roman army. Conditions consistent with degenerative osteoarthritis and true gout (as podagra and chiragra) were described by Celsus and Aretaeus of Cappadocia. Soranus, Rufus of Ephesus and Galen also wrote on orthopedic subjects. We will today differ from many statements made in the Corpus Hippocraticum, but it is clear that the orthopedic basis laid by those documents was not seriously challenged for 1 000 years.
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Tang, Chao-Hsiun, Wesley Furnback, Bruce C. M. Wang, Jackson Tang, Vicky Wei-Hsuen Huang, Derek Tang, Meng-Yao Lu, and Khaled M. Musallam. "Greater Red Blood Cell Transfusion Burden Is Associated with More Healthcare Resource Utilization in Patients with Beta-Thalassemia." Blood 134, Supplement_1 (November 13, 2019): 5790. http://dx.doi.org/10.1182/blood-2019-122747.
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Introduction: Previous studies have examined the total healthcare resource utilization (HCRU) of patients with beta-thalassemia in relation to the general population. However, limited studies have examined the impact of red blood cell transfusion (RBCT) burden on broad aspects of HCRU beyond transfusion costs among patients with beta-thalassemia. Methods: Patients with beta-thalassemia in Taiwan's National Health Insurance Research Database (NHIRD) in 2016 were identified (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] of D56.1). The index date was the first medical claim in the database after 2001. Identified patients were followed from the index date until the end of the study period (December 31, 2016). During the follow-up period, RBCT units and HCRU (all-cause and thalassemia-related) were measured. Thalassemia-related HCRU was defined as any HCRU claim accompanied by a thalassemia or beta-thalassemia diagnosis code. To control for the different lengths of follow-up between patients, both RBCT units and HCRU were reported as the average per 12 weeks over the entire follow-up period. Patients were categorized into 4 cohorts based on the average number of RBCT units received per 12 weeks during follow-up: 0 RBCT units; > 0 to < 6 RBCT units; ≥ 6 to < 12 RBCT units; or ≥ 12 RBCT units. HCRU outcomes of interest were hospital admissions, hospitalized days, outpatient visits, and emergency room (ER) visits. Descriptive statistics were computed to describe HCRU observed in each cohort. Results: A total of 2,984 patients with beta-thalassemia were included in the analysis, with a mean follow-up of 6.87 years. Mean age at index was 37.8 (standard deviation 23.7) years, and 1,903 (63.8%) patients were female. A total of 1,616 (54.2%) patients did not receive RBCT units during the follow-up period. Of the remaining 1,368 patients, 1,112 (81.3%) received > 0 to < 6 RBCT units, 112 (8.2%) received ≥ 6 to < 12 RBCT units, and 144 (10.5%) received ≥ 12 RBCT units per 12 weeks during follow-up. Mean all-cause and thalassemia-related HCRU was higher for transfused patients than for non-transfused patients across all HCRU categories. Thalassemia-related hospital admissions, hospitalized days, and outpatient days all increased as the transfusion burden increased. Patients in the cohort with the highest average transfusion burden (≥ 12 RBCT units per 12 weeks) had numerically greater mean thalassemia-related hospital admissions (0.5; standard error [SE] = 0.04), hospitalized days (2.5; SE = 0.21), and outpatient visits (4.9; SE = 0.41) than the other cohorts (Figure). Conclusions: Patients with beta-thalassemia and higher average transfusion burden during the follow-up period had additional HCRU compared with patients who required fewer RBCT units. These data may support physician and payer understanding of the downstream economic impact of RBCT burden in beta-thalassemia. Disclosures Tang: GSK: Consultancy; Roche: Research Funding; Pfizer: Research Funding; Janssen: Research Funding; Amgen: Research Funding. Furnback:Sanofi: Consultancy; Regeneron: Consultancy; Celgene Corporation: Consultancy; Abbott: Consultancy; Astellas: Consultancy; Pfizer: Consultancy; Eli Lilly: Consultancy; Janssen: Consultancy; Johnson & Johnson: Consultancy; Gilead: Consultancy; Novocure: Consultancy; Progentec Diagnostics: Consultancy; Becton Dickinson: Consultancy; AstraZeneca: Consultancy; Bristol-Myers Squibb: Consultancy. Wang:Gilead Sciences: Consultancy, Equity Ownership; Celgene Corporation: Consultancy, Equity Ownership; Regeneron Pharmaceuticals: Consultancy, Equity Ownership; Novocure: Consultancy; Pfizer: Consultancy; Eli Lilly: Consultancy; Johnson & Johnson: Consultancy; Astellas: Consultancy; Amgen, Vertex Pharma, Illumina, Biogen, Alexion Pharma, Incyte, Biomarin Pharma, Seattle Genetics, Sarepta Therapeutics, Array Biopharma, Ionis Pharma, Sage Therapeutics, Mylan NV, Neurocrine Biosciences, Bio Techne Corp, Jazz Pharma, Alnylam Pharma, Blue: Equity Ownership. Tang:Asclepius Analytics: Employment. Huang:Celgene Corporation: Employment. Tang:Celgene Corporation: Employment, Equity Ownership. Musallam:Celgene Corporation: Consultancy.
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Tsutsué, Saaya, Takahiro Suzuki, Hyojin Kim, William YuanHao Kuan, and Bruce Crawford. "Real-World Assessment of Nationwide Health Economic Burden and Treatment-Based Survival for Current Myelodysplastic Syndromes Treatment Practice in Japan." Blood 136, Supplement 1 (November 5, 2020): 36–37. http://dx.doi.org/10.1182/blood-2020-137136.
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Introduction: Myelodysplastic syndromes (MDS) are a group of progressive clonal hematopoietic malignancies that primarily affect an elderly demographic. MDS is treated based on age, symptoms, disease severity, and prognostic scoring. There is limited evidence on the health economic burden and how transfusion dependency affects clinical outcomes of patients with MDS in Japan. This is the first retrospective database analysis study that was performed to elucidate the patient baseline characteristics, 1-year medical costs, and 3-year overall survival (OS) in patients treated for MDS using an administrative claims database of more than 150 hospitals in Japan. Methods: In this study, we used the Medical Data Vision (MDV) database to identify patients diagnosed with MDS (International Classification of Diseases, Tenth Revision, [ICD-10]: code D46.9) using a nationwide administrative database comprising anonymized data covering more than 25 million patients. Patients who received transfusions, erythropoiesis-stimulating agents (ESA) with or without transfusions, azacitidine (AZA) with or without transfusions, and other (e.g. chemotherapy such as doxorubicin, cytarabine) as the index treatment during the identification period from October 1, 2009 to June 30, 2018 were included if they had 1 year of lookback data before the index date and a follow-up period of ≥ 1 year. Results: Of the 5,981 patients with MDS who met the eligibility criteria for this study, 37.8% were female; the median age of patients was > 70 years. Patients receiving transfusion in their index line of therapy was the largest regimen group (n = 2,844, 47.6%), followed by AZA + transfusion (n = 703, 11.8%), ESA (n = 294, 4.9%), and AZA (n = 288, 4.8%). The AZA regimen had the youngest mean age of 70.2 years while the ESA + transfusion group had the oldest (77.8 years). AZA and AZA + transfusion groups recorded a median Charlson Comorbidity Index score of 1.9 and 2.0, respectively, whereas ESA and ESA + transfusion groups had a mean score of 3.2 and 2.6, respectively. Medical costs varied widely for these groups (Figure 1). Mean overall costs were highest for the AZA + transfusion regimen group (USD 63,226) and lowest for the ESA group (USD 15,931). Mean overall costs for regimen groups without transfusion were highest for AZA (USD 47,475), followed by ESA (USD 15,931; P < 0.0001), and the addition of the transfusion component was observed to incur higher overall costs, inpatient costs, and MDS-related treatment costs. Inpatient costs for the ESA groups ranged from USD 16,717 for ESA only to USD 30,347 for ESA + transfusion. The highest outpatient costs were observed for the AZA group (USD 20,011; P < 0.0001). MDS-related treatment costs were highest for the AZA + transfusion group (USD 32,123) and lowest for the ESA group (USD 2,518; P < 0.0001). Overall, there were 1,966 deaths (32.9%) recorded within 3 years of index treatment. The median OS for patients receiving AZA + transfusion was 957 days (Figure 2). Conclusions: In this study, mean overall costs, inpatient costs, and outpatient costs were highest for the AZA + transfusion regimen group. Consistent with the trend of MDS studies, the majority of patients with MDS received supportive transfusion-dependent therapy. Transfusion dependency led to considerable incremental cost and poorer clinical outcomes compared with other regimens. This study provides insights into the real-world disease burden for patients with MDS and the current treatment options available for MDS in Japan. Disclosures Tsutsué: Celgene KK, a Bristol-Myers Squibb Company: Current Employment. Suzuki:Bristol Myers Squibb: Honoraria; Nippon Shinyaku Co., Ltd: Honoraria; Kyowa Hakka Kirin Co., Ltd: Honoraria, Research Funding; Novartis Pharmaceuticals: Honoraria. Kim:Syneos Health: Current Employment. Kuan:Syneos Health Clinical K.K.: Current Employment. Crawford:Syneos Health: Current Employment.