Measuring medication adherence in older community-dwelling patients with multimorbidity

Abstract

Purpose

Older people with several chronic conditions require multiple drugs from different classes to be adequately treated. This study aims to: (i) measure medication adherence across multiple conditions and therapeutic drug groups in older community-dwelling patients, and (ii) examine the effect of multimorbidity on adherence.

Methods

This is a retrospective cohort study of medication adherence in 855 community-dwelling patients aged ≥ 70 years from 15 practices in Ireland using the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. Multimorbidity was measured using the RxRisk-V and by the number of different drug classes. The RxRisk-V algorithm classifies prescription drug fills into 45 chronic disease classes for older populations based on the WHO Anatomical Therapeutic Chemical classification system. Adherence to medications was assessed by: (i) calculating the average medication possession ratio (MPR) per patient and (ii) an MPR< 80%.

Results

The overall median MPR for the cohort was 0.83 (IQR 0.69, 0.91). The conditions with the highest MPRs were hypothyroidism (mean MPR = 0.88, SD = 0.20) and type 2 diabetes (mean MPR = 0.83, SD = 0.19), followed by heart disease. On average, 20–40% of patients were non-adherent (MPR < 80%) across all conditions. There was an inverted U-shaped relationship between the mean MPR and number of morbidities and drug classes. Adherence varied per patients' morbidity burden, with higher adherence for certain combinations of chronic conditions.

Conclusion

In total, 31% of older patients with multimorbidity were non-adherent to their medication but adherence levels varied across treatment categories and chronic conditions.

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Are Electric Toothbrushes Better?

Well, for your mouth, anyway. . "There's a biofilm of bacteria that builds up in our mouths and our teeth and even in our gums.

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Botulinum toxin A for patients with orofacial dystonia: prospective, observational, single-centre study

The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre –post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS). (Source: International Journal of Oral and Maxillofacial Surgery)

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A Novel and Highly Sensitive Real-Time nested RT-PCR Assay in a Single Closed Tube for Detection of Enterovirus

Publication date: Available online 2 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Xin-xin Shen, Fang-zhou Qiu, Huai-long Zhao, Meng-jie Yang, Liu Hong, Song-tao Xu, Shuai-feng Zhou, Gui-xia Li, Zhi-shan Feng, Xue-jun Ma
The sensitivity of qRT-PCR assay is not adequate for the detection of the samples with lower viral load, particularly in the cerebrospinal fluid (CSF) of patients. Here, we present the development of a highly sensitive real-time nested RT-PCR (RTN RT-PCR) assay in a single closed tube for detection of human enterovirus (HEV). The clinical performance of both RTN RT-PCR and qRT-PCR was also tested and compared using 140 CSF and fecal specimens.The sensitivities of RTN RT-PCR assay for EV71, Coxsackievirus A (CVA)16, CVA6 and CVA10 achieved 10⁻⁸ dilution with a corresponding Ct value of 38.20,36.45,36.75 and 36.45, respectively, which is equal to traditional two-step nested RT-PCR assay and approximately 2–10 fold lower than that of qRT-PCR assay. The specificity of RTN RT-PCR assay was extensively analyzedin Silico and subsequently verified using the reference isolates and clinical samples. Sixteen qRT-PCR-negative samples were detected by RTN RT-PCR and a variety of enterovirus serotypes was identified by sequencing of inner PCR products. We conclude RTN RT-PCR is more sensitive than qRT-PCR for the detection of HEV in clinical samples.



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Frequency of Small-Colony Variants and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus in Cystic Fibrosis Patients

Publication date: Available online 2 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Nuntra Suwantarat, Mayer Rubin, Latetia Bryan, Tsigereda Tekle, Michael P. Boyle, Karen C. Carroll, Mark T. Jennings
BackgroundSmall-colony variants (SCVs) are a distinct phenotype of S. aureus, known for their role in chronic, difficult to treat infections, including cystic fibrosis (CF) lung disease. The goal of this study was to characterize SCV MRSA infection in an adult and pediatric CF population and to identify antibiotic susceptibility patterns unique to SCV MRSA.MethodsWe recovered methicillin-resistant Staphylococcus aureus (MRSA) from respiratory culture samples from CF patients at the Johns Hopkins Hospital during a 6month study period.ResultsOf 1161 samples, 200 isolates (17%) were identified as MRSA, and 37 isolates from 28 patients were identified as SCV MRSA. A higher proportion of MRSA was found among SCV isolates (37/66, 56%) compared to normal colony variant (NCV) isolates (163/417, 39%), p=0.02. All SCV MRSA isolates from individual patients were susceptible to vancomycin and ceftaroline, but they demonstrated higher rates of antibiotic resistance to trimethoprim/sulfamethoxazole, moxifloxacin, and erythromycin, compared to NCV MRSA isolates. Additionally, individuals with SCV MRSA had lower lung function, higher rates of persistent MRSA infection, and higher rates of previous antibiotic use, compared to individuals with NCV MRSA.ConclusionsA significant proportion of MRSA isolates recovered from patients with CF have the SCV morphology. Compared to individuals with NCV MRSA, those with SCV MRSA have higher rates of persistent MRSA infection and lower lung function. SCV MRSA isolates were more resistant than NCV, but they are highly susceptible to vancomycin, linezolid and ceftaroline.



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Teicoplanin resistance in Staphylococcus haemolyticus is associated with mutations in histidine kinases VraS and WalK

Publication date: Available online 16 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Vladimir Vimberg, Jorunn Pauline Cavanagh, Oldřich Benada, Olga Kofroňová, Erik Hjerde, Leona Zieglerová, Gabriela Balíková Novotná
We investigated the genetic basis of glycopeptide resistance in laboratory-derived strains of S. haemolyticus with emphasis on differences between vancomycin and teicoplanin. The genomes of two stable teicoplanin-resistant laboratory mutants selected on vancomycin or teicoplanin were sequenced and compared to parental S. haemolyticus strain W2/124. Only the two non-synonymous mutations, VraS Q289K and WalK V550L were identified. No other mutations or genome rearrangements were detected. Increased cell wall thickness, resistance to lysostaphin-induced lysis and adaptation of cell growth rates specifically to teicoplanin were phenotypes observed in a sequenced strain with the VraS Q289K mutation. Neither of the VraS Q289K and WalK V550L mutations was present in the genomes of 121S. haemolyticus clinical isolates. However, all but two of the teicoplanin resistant strains carried non-synonymous SNPs in vraSRTU and walKR-YycHIJ operons pointing to their importance for the glycopeptide resistance.



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Evaluation of a human adenovirus viral load assay using the Altona RealStar® PCR test

Publication date: Available online 2 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Hanna Rennert, Girish Ramrattan, Zhengming Chen, Patrick McIntire, Alber Michaeel, Anna Khazanova, Stephen G. Jenkins, John Sipley
This study evaluated the performance of the Altona Diagnostics RealStar® Adenovirus Research Use Only (RUO) real-time PCR reagents for HAdV quantitation in plasma samples from immunodeficient patients. The assay was linear from 2.30–9.17 log10 copies/mL (coefficient of determination; R²=0.998) with limits of detection and quantification of 2.19 log10 and 2.30 log10 copies/mL (>95% positivity rate), respectively. Assay precision was highly reproducible with coefficients of variance ranging from 0% to 4.7%. A comparison of 66 matched samples showed good agreement (R²=0.845) between the Altona and the reference laboratory assay, with an average negative bias (−0.24 log10 copies/mL). Genotyping analysis demonstrated that HAdV species B and C accounted for 77% of the positive samples. A significant (≥0.9 log10) difference in quantitation between both tests was found for three HAdV types (HAdV types A12, B14 and F41). In conclusion, the Altona RealStar® test is a reliable and sensitive assay for HAdV DNA quantitation.



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Phospholipid composition of the outer membrane of Escherichia coli influences its susceptibility against antimicrobial peptide apidaecin 1b

Publication date: Available online 21 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Rico Schmidt, Ding Yonghong, Ralf Hoffmann
Proline-rich antimicrobial peptides (PrAMPs) kill bacteria in a multi-modal mechanism by inhibiting the 70S ribosome (i.e., protein translation) as dominant lethal mechanism besides inhibition of several other proteins, such as chaperone DnaK. PrAMPs pass the outer membrane of Gram-negative bacteria, probably by a self-promoted uptake followed by a transporter-mediated uptake from the periplasm. Mutation of transporter protein SbmA is a well-studied resistance mechanism observed in vitro by resistance induction with PrAMPs. Here, we compared the membrane compositions of Escherichia coli BL21AI and BL21AI Api^r, which was obtained by resistance induction with PrAMP apidaecin 1b. Lipid A was partially modified by phosphatidylethanolamine, 4-aminoarabinose, or both groups, but the relative contents of these and further unidentified species did not differ much between wildtype and resistant strains indicating that resistance was not related to lipid A modifications. The same was true for 20 glycerophospholipids identified, i.e., eleven phosphatidylethanolamines and nine phosphatidylglycerols. However, glycerophospholipids in BL21AI Api^r contained much lower levels of cyclopropane-modified acyl-groups, which probably alters the biophysical properties of the inner membrane and the inner leaflet of the outer membrane. Indeed, when cyclopropane-fatty-acyl-phospholipid synthase was knocked-out in E. coli BW25113, the resulting BW25113 Δcfa was less susceptible against apidaecin 1b.



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A real-time multiplex PCR for the identification and typing of Vibrio cholerae

Publication date: Available online 1 December 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): David R Greig, Tadgh J Hickey, Megan D Boxall, Hafsah Begum, Amy Gentle, Claire Jenkins, Marie A Chattaway
We report the development and validation of a duo-triplex real-time PCR for the rapid identification and typing of Vibrio cholerae. The PCR assay targets a species specific toxR gene present in all strains of V. cholerae and used as a marker for the species, wbeO1 and wbfO139, encoding the O1 and O139 somatic antigens, and ctxA encoding CT. The two tcpA variants associated with the Classical and El-Tor biotypes are used to infer biotype. The assay was evaluated using 178 isolates comprising eight different Vibrio species, including 122 isolates of V. cholerae. The PCR results of 171/178 (96.1%) isolates were concordant with the serotyping, biotyping and expected CT results. Variants of toxR (n=3), non-functional wbeO1 (n=1) and CT negative isolates of V. cholerae O1 (n=3) were likely explanations for the mismatched results. This duo-triplex real-time PCR is a reproducible and robust assay for the rapid identification and typing of V. cholerae belonging to the highly pathogenic, pandemic lineages.



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Failure of daptomycin β-Lactam combination therapy to prevent resistance emergence in Enterococcus faecium

Publication date: Available online 3 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Vidthiya Menon, Rebecca Davis, Nick Shackel, Bjorn A. Espedido, Alicia G. Beukers, Slade O. Jensen, Sebastiaan J. van Hal
Daptomycin β-Lactam combination therapy offers "protection" against daptomycin non-susceptibility (DNS) development in Enterococcus faecium. We report failure of this strategy and the importance of source control. Mutations were detected in the LiaF and cls genes in DNS isolates. A single DNS isolate contained an unrecognized mutation, which requires confirmation.



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Development of a Multiplex TaqMan Real-Time PCR Assay for the Detection of Chlamydia psittaci and Chlamydia pneumoniae in Human Clinical Specimens

Publication date: Available online 27 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Bernard J. Wolff, Shatavia S. Morrison, Jonas M. Winchell
Diagnosis of Chlamydia psittaci and Chlamydia pneumoniae infections has traditionally relied on serological assays. We developed a multiplex real-time PCR assay for detection of C. psittaci, C. pneumoniae and an internal control. Results of this assay demonstrated 100% concordance compared to results of previously tested human clinical specimens.



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Underdiagnosis of Chlamydia trachomatis and Chlamydia psittaci revealed by Introduction of Respiratory Multiplex PCR assay with Chlamydiaceae family Primers

Publication date: Available online 26 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Vinita Rane, Kong Khailin, Jackie Williams, Michelle Francis, Despina Kotsanas, Tony M. Korman, Maryza Graham
We describe unanticipated detection of respiratory infection with Chlamydia trachomatis and Chlamydia psittaci after introduction of respiratory multiplex polymerase chain reaction assay that includes Chlamydiaceae family primers. We detected cases of pediatric C. trachomatis and of adult C. psittaci infection in patients with previously unrecognized risk factors. Directed testing for C. trachomatis and C. psittaci based on clinical features and risk factors alone is likely to miss the majority of infected cases.



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A novel host-protein assay outperforms routine parameters for distinguishing between bacterial and viral lower respiratory tract infections

Publication date: Available online 24 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Michal Stein, Shelly Lipman-Arens, Kfir Oved, Asi Cohen, Ellen Bamberger, Roy Navon, Olga Boico, Tom Friedman, Liat Etshtein, Meital Paz, Tanya M. Gottlieb, Or Kriger, Yura Fonar, Ester Pri-Or, Renata Yacobov, Yaniv Dotan, Amit Hochberg, Moti Grupper, Irina Chistyakov, Israel Potasman, Isaac Srugo, Eran Eden, Adi Klein
Bacterial and viral lower respiratory tract infections (LRTIs) are often clinically indistinguishable, leading to antibiotic overuse. We compared the diagnostic accuracy of a new assay that combines three host-biomarkers (TRAIL, IP-10, CRP) with parameters in routine use to distinguish bacterial from viral LRTIs. Study cohort included 184 potentially eligible pediatric and adult patients. Reference standard diagnosis was based on adjudication by an expert panel following comprehensive clinical and laboratory investigation (including respiratory PCRs). Experts were blinded to assay results and assay performers were blinded to reference standard outcomes. Evaluated cohort included 88 bacterial and 36 viral patients (23 did not fulfill inclusion criteria; 37 had indeterminate reference standard outcome). Assay distinguished bacterial from viral LRTI patients with sensitivity of 0.93±0.06 and specificity of 0.91±0.09, outperforming routine parameters, including WBC, CRP and chest x-ray signs. These findings support the assay's potential to help clinicians avoid missing bacterial LRTIs or overusing antibiotics.



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Evaluation of the molecular Xpert Xpress Flu/RSV assay versus Alere i Influenza A & B assay for rapid detection of influenza viruses

Publication date: Available online 24 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): JH Chen, HY Lam, CC Yip, VC Cheng, JF Chan, TH Leung, S Sridhar, KH Chan, BS Tang, KY Yuen
A new FDA-approved Xpert Xpress Flu/RSV assay has been released for rapid influenza virus detection. We collected 134 nasopharyngeal specimens to compare the diagnostic performance of the Xpert assay and the Alere i Influenza A & B assay for influenza A and B viruses detection. The Xpert assay demonstrated 100% and 96.3% sensitivity to influenza A and influenza B virus respectively. Its specificity was 100% for both viruses. The Alere i assay demonstrated slightly lower sensitivity but similar specificity to the Xpert Xpress assay. Although the Xpert assay (30 mins) required longer processing time than the Alere assay (15 mins), the handling procedure of the Alere assay was more complicated than the Xpert assay. As the GenXpert system has higher throughput than the Alere system, it is more suitable for hospital clinical laboratories. Overall, the new Xpert Xpress Flu/RSV assay is a reliable and useful tool for rapid influenza detection.



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Evaluation of Loopamp™MTBC detection kit for diagnosis of pulmonary tuberculosis at a peripheral laboratory in a high burden setting

Publication date: Available online 21 November 2017
Source:Diagnostic Microbiology and Infectious Disease
Author(s): Van Anh Thi Nguyen, Hung Van Nguyen, Thuong Van Dinh, Ha Hoang Du, Chinh Nhu Do, Guy B. Marks, Nhung Viet Nguyen
The Loopamp™MTBC detection kit (TB-LAMP) was designed to replace the sputum smear microscopy for the diagnosis of pulmonary tuberculosis. We evaluated its performance at a peripheral laboratory in Vietnam. The sensitivity of TB-LAMP was 45.5% [28.1% - 63.6%], which was equal to three-sputum smear microscopy but lower than that of Xpert MTB/RIF (87.8% [71.8% - 96.6%]). In patients with culture-confirmed TB, sensitivity was 80% [51.9% - 95.7%] in smear-positive and 16.7% [3.5% - 41.4%] in smear-negative cases. The specificity of TB-LAMP was 95.1% (92.7% - 96.9%), which was lower than that of smear microscopy (98.9% [97.5% - 99.7%]) and Xpert MTB/RIF (99.3% [98.1% - 99.9%]) (p<0.05). The probability of TB detection by TB-LAMP was more influenced by sample quality and viscosity than were smear microscopy, Xpert MTB/RIF and culture. The present data do not support the use of TB-LAMP as a replacement test for smear microscopy in peripheral laboratories.



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Board tosses out all but 4 allegations against Lewiston dentist

Attorneys James Belleau and Adam Lee listen with their client Dr. Jan Kippax as the Board of Dental Practice deliberates whether allegations against him should be dismissed. The case against a Lewiston dentist accused of putting the health and safety of his patients in immediate jeopardy is significantly weaker than it was a few weeks ago.

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Sirona Dental Systems (SIRO) & Its Competitors Head-To-Head Contrast

Sirona Dental Systems is one of 79 publicly-traded companies in the "Advanced Medical Equipment & Technology" industry, but how does it compare to its peers? We will compare Sirona Dental Systems to related businesses based on the strength of its risk, valuation, profitability, institutional ownership, earnings, dividends and analyst recommendations. 51.7% of shares of all "Advanced Medical Equipment & Technology" companies are held by institutional investors.

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Flaws in the application and interpretation of statistical analyses in systematic reviews of therapeutic interventions were common: a cross-sectional analysis

Publication date: Available online 2 December 2017
Source:Journal of Clinical Epidemiology
Author(s): Matthew J. Page, Douglas G. Altman, Joanne E. McKenzie, Larissa Shamseer, Nadera Ahmadzai, Dianna Wolfe, Fatemeh Yazdi, Ferrán Catalá-López, Andrea C. Tricco, David Moher
ObjectivesTo investigate the application and interpretation of statistical analyses in a cross-section of systematic reviews (SRs) of therapeutic interventions, without restriction by journal, clinical condition, or specialty.Study Design and SettingWe evaluated a random sample of SRs assembled previously, which were indexed in MEDLINE® during February 2014, focused on a treatment or prevention question, and reported at least one meta-analysis. The reported statistical methods used in each SR were extracted from articles and online appendices by one author, with a 20% random sample extracted in duplicate.ResultsWe evaluated 110 SRs; 78/110 (71%) were non-Cochrane SRs, and 55/110 (50%) investigated a pharmacological intervention. The SRs presented a median of 13 (interquartile range 5-27) meta-analytic effects. When considering the index (primary or first reported) meta-analysis of each SR, just over half (62/110 [56%]) used the random-effects model, but few (5/62 [8%]) interpreted the meta-analytic effect correctly (as the average of the intervention effects across all studies). A statistical test for funnel plot asymmetry was reported in 17/110 (15%) SRs, however, in only 4/17 (24%) did the test include the recommended number of at least 10 studies of varying size. Subgroup analyses accompanied 42/110 (38%) index meta-analyses, but findings were not interpreted with respect to a test for interaction in 29/42 (69%) cases, and the issue of potential confounding in the subgroup analyses was not raised in any SR.ConclusionsThere is scope for improvement in the application and interpretation of statistical analyses in SRs of therapeutic interventions. Involvement of statisticians on the SR team, and establishment of partnerships between researchers with specialist expertise in SR methods and journal editors may help overcome these shortcomings.



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Claiming desmopressin therapeutic equivalence in children requires pediatric data: a population PKPD analysis

Abstract

Purpose

For a new formulation of a drug, only pharmacokinetic bioequivalence with the original formulation has to be demonstrated in healthy, young adults. However, "children are not small adults," and to guarantee a safe and effective treatment, age-adapted drug development is required. Desmopressin, a vasopressin analogue prescribed for nocturnal enuresis in children, was studied as an example formulation first developed in adults and then extrapolated to a pediatric indication.

Methods

Population pharmacokinetic and pharmacodynamic modeling was used to analyze previously published desmopressin data of 18 children suffering from nocturnal enuresis. The main objective was the comparison of the therapeutic equivalence of two desmopressin formulations: tablet and lyophilisate. The measurements for pharmacokinetics and pharmacodynamics were respectively plasma desmopressin concentration and urine osmolality and diuresis.

Results

The half maximal inhibitory concentration for inhibition of urine production was 0.7 pg/mL lower for the lyophilisate than for the tablet. The effect of formulation on the half maximal inhibitory concentration seems to suggest that the 120-μg lyophilisate has a more pronounced effect on the urine volume and osmolality than the 200-μg tablet, even when the same exposure is achieved.

Conclusions

A new indirect response model for desmopressin was constructed and validated, using a previously built pharmacokinetic model and additional pharmacodynamic data. In order to draw solid conclusions regarding the efficacy and safety of desmopressin in children, pharmacokinetics and pharmacodynamics data should be analyzed together. This study adds proof to potential differences in pediatric and adult pharmacokinetic and pharmacodynamic properties of desmopressin and exemplifies the need for pediatric clinical trials, not only for every new drug but also for every new formulation.

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Baclofen in gamma-hydroxybutyrate withdrawal: patterns of use and online availability

Abstract

Purpose

Gamma-hydroxybutyrate (GHB) withdrawal is a life-threatening condition that does not always respond to standard treatment with benzodiazepines. Baclofen has potential utility as a pharmacological adjunct and anecdotal reports suggest that it is being used by drug users to self-manage GHB withdrawal symptoms. Here, we investigate current patterns of use and the online availably of baclofen.

Methods

Data triangulation techniques were applied to published scientific literature and publicly accessible Internet resources (grey literature) to assess the use of baclofen in GHB withdrawal. An Internet snapshot survey was performed to identify the availability of baclofen for online purchase and the compliance of retailers with the UK regulations. Data were collected according to pre-defined criteria.

Results

A total of 37 cases of baclofen use in GHB withdrawal were identified in the scientific literature, as well as 51 relevant discussion threads across eight Internet forums in the grey literature. Baclofen was available to purchase from 38 online pharmacies, of which only one conformed to the UK regulations.

Conclusions

There is limited published evidence on the use of baclofen in GHB withdrawal, but both scientific and grey literature suggests clinical utility. Online pharmacies are readily offering prescription-only-medication without prescription and due to inadequate regulation, pose a danger to the public.

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Mycology of chronic suppurative otitis media-cholesteatoma disease: An evaluative study

Publication date: Available online 2 December 2017
Source:American Journal of Otolaryngology
Author(s): Gautam Bir Singh, Medozhanuo Solo, Ravinder Kaur, Rubeena Arora, Sunil Kumar
Aims & objectivesTo detect the prevalence of fungus in chronic suppurative otitis media-cholesteatoma disease and to evaluate its clinical significance.Study designProspective observational study conducted in a sample size of 46 patients at a tertiary care university teaching hospital.Materials & methodsForty six patients suffering from chronic suppurative otitis media-cholesteatoma disease were recruited in this prospective study. Data was duly recorded. Cholesteatoma sample was procured at the time of mastoid surgery and microbiologically analysed for fungal infestation. Clinical correlation to fungus infestation of cholesteatoma was statistically analysed.ResultsOut of the recruited 46 patients, post-operatively cholesteatoma was seen in 40 cases only. Seventeen i.e. 42.5% of these cases had fungal colonization of cholesteatoma. Further a statistically significant correlation between persistent otorrhoea and fungal infestation of cholesteatoma was observed. Three cases of fungal otomastoiditis were also recorded in this study, but a statistically significant correlation between complications and fungus infestation of cholesteatoma could not be clearly established.ConclusionsThere is fungal colonization of cholesteatoma which is pathogenic and can cause persistent otorrhoea.



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Commentary to letter to the editor to manuscript “Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life”

Publication date: Available online 2 December 2017
Source:American Journal of Otolaryngology
Author(s): Katharina Stölzel




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Table of Contents

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From testing to diagnostic strategies and dia-prognostic research

The development of diagnostic technologies is moving fast and is accelerating. But while the methodology of diagnostic research has made progress in the past decades, it still lags far behind that for evaluating treatments. One of the reasons is the broad and complex field of applications of diagnostic tests, such as detecting or excluding disease; contributing to patient care and management; assessment of prognosis; monitoring clinical course; and measurement of general health or fitness [1].

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Reviewer Award

High quality of published research cannot be achieved without high quality peer review of submitted manuscripts. Good reviews are critical, but also provide authors with constructive comments to make their manuscripts even better. As an editorial team, we are extremely grateful to all our colleagues who have volunteered their expertise and have taken time out of their busy schedules to participate in the peer review for our journal. They helped us to make good editorial decisions and to safeguard the quality of the papers that were published in the past year.

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Acknowledgment of Reviewers

Abou-Setta Ahmed

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Editorial Board

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David Sackett Young Investigator Award

In 2015, the Journal of Clinical of Epidemiology has initiated the annual David Sackett Young Investigator Award. This award is in the spirit of the late David L. Sackett, who over many decades and in numerous ways has continuously inspired and educated generations of young investigators in the fields of clinical epidemiology and evidence-based medicine.

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Making A Great First Impression With Your Smile

According to a survey commissioned by the American Academy of Cosmetic Dentistry almost half of adults consider a smile to be the most memorable feature when first meeting someone! A nice smile not only aids in initiating personal relationships, but is important for excelling in the professional world. So, shouldn't your profile picture on social media sites like LinkedIn, Facebook, Twitter, etc.

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Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery

Unilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility.

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Intestinal permeability and Ménière's disease

Ménière disease (MD) is a multifactorial chronic disabling condition characterized by episodic vertigo, ear fullness, and hearing loss. MD patients often complain of aspecific gastrointestinal symptoms associated with autonomic dysregulation, frequently outweighed by the otological manifestations. Dietary modifications have been reported to improve the typical MD symptoms in some cases. Our purpose was to test the urinary levels of lactulose and mannitol (double sugar test) and the fecal calprotectin, both markers of altered intestinal permeability, in subjects with definite MD in an active and inactive stage.

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Botulinum toxin A for patients with orofacial dystonia: prospective, observational, single-centre study

The objective of this study was to demonstrate the efficacy of intramuscular botulinum toxin type A (BTX-A) as a method of controlling the symptoms of focal facial dystonia. A prospective, longitudinal, observational, pre–post (case-series) single-centre study was conducted over a period of 3 months, involving 30 patients with focal dystonia. The patients were enrolled on a first-come, first-served basis. For all patients, the abnormal movements were evaluated using the Abnormal Involuntary Movement Scale (AIMS).

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An evaluation of four modes of low-dose anticoagulation during intermittent haemodialysis

Abstract

Introduction

Intensive care participants that need dialysis frequently suffer from increased risk of bleeding. Standard intermittent haemodialysis (SHD) includes anticoagulation to avoid clotting of the dialysis system. The aim of this study was to clarify which of four different low-dose anticoagulant modes was preferable in reducing the exposure to i.v. unfractionated heparin (heparin) and maintaining patency of the dialysis circuit.

Methods

Twenty-three patients on SHD were included to perform haemodialysis with four modes of low-dose anticoagulation. For comparative analyses, patients served as their own control. Haemodialysis with a single bolus of tinzaparin at the start was compared to haemodialysis initiated without i.v. heparin but priming with (1) heparin in saline (H), (2) heparin and albumin in saline (HA), (3) heparin and albumin in combination with a citrate-containing dialysate (HAC), (4) saline and usinga heparin-coated filters (Evodial®). The priming fluid was discarded before dialysis started. Blood samples were collected at 0, 30 and 180 min during haemodialysis. Smaller bolus doses of heparin (500 Units/dose) were allowed during the modes to avoid interruption by clotting.

Findings

The mean activated partial thromboplastin (APTT) time as well as the doses of anticoagulation administered was highest with SHD and least with HAC and Evodial®. Mode H versus SHD had the highest rate of prematurely interrupted dialyses (33%, p = 0.008). The urea reduction rate was less with Evodial® vs. SHD (p < 0.01). One hypersensitivity reaction occurred with Evodial®. Changes in blood cell concentrations and triglycerides differed between the modes.

Discussion

If intermittent haemodialysis is necessary in patients at risk of bleeding, anticoagulation using HAC and Evodial® appeared most preferable with least administration of heparin, lowest APTT increase and lowest risk for prematurely clotted dialyzers in contrast to the least plausible H mode.

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Factors influencing recurrent emergency department visits for epistaxis in the elderly

Our objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly.

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Sex Differences in Sleep-Disordered Breathing After Stroke: Results from the BASIC Project

Sleep-disordered breathing (SDB), an independent risk factor for stroke, is associated with worse post-stroke outcomes. Differences in the relationship between SDB and stroke may exist for women versus men. In this population-based study, we compared the prevalence of both pre- and post-stroke SDB by sex. We also explored whether menopausal status is related to post-stroke SDB.

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Association between Extracellular Material and Biofilm Formation in Response to Sodium Hypochlorite by Clinical Isolates of Enterococcus faecalis

Extracellular material (ECM) surrounding Enterococcus faecalis may play a role in increasing resistance to environmental stresses. Our aim was to determine ECM levels in response to subminimal inhibitory concentrations of sodium hypochlorite (sub-MIC/NaOCl) or anaerobic growth and determine the impact on biofilm development.

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Anesthetic Efficacy of Supine and Upright Positions for the Inferior Alveolar Nerve Block: A Prospective, Randomized Study

It has been recommended to place patients in an upright position after administration of an inferior alveolar nerve block (IANB), theoretically allowing the anesthetic to diffuse in an inferior direction and resulting in better pulpal anesthesia. The purpose of this study was to compare an upright versus a supine position on the success of pulpal anesthesia when an IANB was administered in asymptomatic teeth.

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Influence of Cervical Preflaring on the Incidence of Root Dentin Defects

This study evaluated the influence of cervical preflaring on the incidence of root dentin defects after root canal preparation.

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Survival Rates from Fracture of Endodontically Treated Premolars Restored with Full-coverage Crowns or Direct Resin Composite Restorations: A Retrospective Study

The aim of the present study was to compare the survival rates against fracture of premolar endodontically treated teeth (ETT) restored with resin composite or crowns and to identify risk factors associated with the fracture.

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Guideline on terminology and definitions of updating clinical guidelines: the Updating Glossary

The Guidelines International Network (G-I-N) Updating Guidelines Working Group launched an initiative to develop a glossary (the Updating Glossary) with domains, terms, definitions, and synonyms related to updating of clinical guidelines (CGs).

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Milton dentist pioneering sensory-based care for patients with special needs

A local dentist is leading the charge when it comes to revolutionizing the way that patients with special needs are cared for. Dr. Alison Sigal of Milton and her father, also a dentist, recently opened the doors to Little Bird Pediatric Dentistry on Steeles Avenue.

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Accuracy of computer-assisted orthognathic surgery

The purpose of this study was to retrospectively evaluate the difference between the planned and the actual movements of the jaws, using three-dimensional (3D) software for PC-assisted orthognathic surgery, to establish the accuracy of the procedure.

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Outcomes of Zika virus infection during pregnancy: contributions to the debate on the efficiency of cohort studies

Zika infection during pregnancy (ZIKVP) is known to be associated with adverse outcomes. Studies on this matter involve both rare outcomes and rare exposures and methodological choices are not straightforward....

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Life satisfaction and longitudinal changes in physical activity, diabetes and obesity among patients with cardiovascular diseases

Patients with cardiovascular disease who underwent coronary angiography at the National Institute of Cardiac Surgery and Cardiological Intervention (INCCI) in Luxembourg were surveyed for cardiovascular risk fact...

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Social and health outcomes following upgrades to a national housing standard: a multilevel analysis of a five-wave repeated cross-sectional survey

While existing research indicates that housing improvements are associated with health improvements, less is known about the wider social and health benefits of meeting national housing standards, as well as t...

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Success and failure in narrowing the disability employment gap: comparing levels and trends across Europe 2002–2014

International comparisons of the disability employment gap are an important driver of policy change. However, previous comparisons have used the European Union Statistics on Income and Living Conditions (EU-SI...

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Filling Financial Cavities: How A Loan Forgiveness Program Would Help Dental School Grads

Dread paying the bill after a trip to the dentist? Dental school graduates may have it worse: their student loans. The average dental student graduates with more than $261,000 worth of debt, according to the American Dental Education Association .

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Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013

Publication date: Available online 2 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): K. Pujo, P. Philouze, A. Scalabre, P. Céruse, M. Poupart, G. Buiret
ObjectivesSalvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure.Patients and methodA retrospective multicenter study included 52 patients treated by salvage surgery for recurrence of laryngeal or hypopharyngeal squamous cell carcinoma after radiation therapy between 2005 and 2013.ResultsFactors associated with improved 3-year overall survival on univariate analysis comprised laryngeal primary (P=0.001), laryngeal recurrence (P=0.026), rT1, rT2 or rT3 rather than rT4 tumor (P=0.007), previous chemotherapy (P=0.036), and neck dissection during salvage surgery (P=0.005), the last of these being confirmed on multivariate analysis. Five-year overall survival was 36.0% (range, 27.6–44.4%), for a median 23.04 months (95% CI, 19.44–26.64). Five-year disease-free survival was 23.5% (range, 16.0–31.0%), for a median 8.04 months (95% CI, 2.04–14.04).ConclusionSalvage surgery for laryngeal or hypopharyngeal cancer is difficult, and survival is not good. Laryngeal primary and recurrence location, moderate tumor volume and extension (<T4), prior chemotherapy and neck dissection during salvage surgery were associated with better overall and disease-free survival, which should enable better patient selection.



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Let's not twist and spin-doctor our articles

Publication date: Available online 1 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): O. Laccourreye, H. Maisonneuve




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Jawbone loss predates rheumatoid arthritis

IMAGE: In the above x-ray image, the white dotted line indicate the normal jawbone level at a molar site in the lower jaw. The individual has periodontitis and has therefore lost... view Jawbone loss caused by periodontitis predates the onset of rheumatoid arthritis.

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Head and neck Merkel cell carcinoma: a retrospective case series and critical literature review with emphasis on treatment and prognosis

Publication date: Available online 2 December 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ioannis Papadiochos, Anna Patrikidou, Aikaterini Patsatsi, Doxa Mangoudi, Henri Thuau, Konstantinos Vahtsevanos
ObjectiveMerkel cell carcinoma (MCC) is a rare cutaneous malignancy with a high recurrence and mortality rates. More than half of MCCs occur in the head and neck region. This paper aims to present a retrospective case series study of primary MCCs of the head and neck treated in our department over 12 years.Study DesignSix patients were identified, and their characteristics, treatment modalities, and outcomes are reported. A critical review of the current literature is also included to provide up-to-date information on MCCs with special emphasis on treatment modalities and disease prognosis.ResultsManagement of head and neck MCCs requires early and accurate diagnosis and includes surgery, radiotherapy, and/or combination chemotherapy. Accurate cervical nodal staging is of paramount importance before establishing the definite treatment plan.ConclusionsThe results of both our case series and literature data review indicate that elective management of regional lymph nodes is recommended instead of an observation approach for patients with no identifiable disease in the lymph nodes (cN0). Because the majority of MCCs arise in the head and neck region, oral and maxillofacial surgeons are likely be the first professionals who will encounter this disease and should therefore be aware of the current diagnostic and treatment modalities.



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Healing ability and diameter growth of lime-trees ( Tilia begonifolia Stev.) following logging wounds

Abstract

Lime-trees (Tilia begonifolia Stev.) have countless ecological and economical values in the northern forests of Iran. Bole wounds on residual trees are commonly caused by logging. The healing ability of bole wounds and the effect of bole wounds on diameter growth in lime-trees were assessed in a natural mixed uneven-age stand. The susceptibility to decay in relation to the wound severity was also evaluated. Condition and location of lime-trees before and after selective logging were determined through systematic plot sampling. The position of each lime-tree was identified on a topographical map using the global positioning system. After 10 years from wound occurrence, tree and wound characteristics were also re-measured. Overall, 68 stems (9.7 stem ha⁻¹) of lime-trees were found in the sampled area, 25 stems (36.8%) were damaged in the form of bole wound, and 43 stems (63.2%) were undamaged. Statistical differences between wounded or non-wounded lime-trees in terms of diameter and height were not found. Most of the wounds occurred at the height of < 1 m; the average wound size was 370.5 cm². Wound severity was related to wound size and wound position. Wound width healing rate was 6.2 mm year⁻¹. The wound shape was found to be a healing factor as the healing rate by width was higher than that by length. Healed wounds were only 12, 60% of bole wounds resulted in decay. Diameter growth of wounded trees was 43.5% lower than undamaged trees. The average annual diameter growth decreased by increasing wound severity. The results indicated the lime-tree is a very sensitive species to damage caused by logging (bole wound). Single-tree selection cutting needs more careful logging operations to reduce damage on residual lime-trees in order to safeguard this species, valuable in ecologic and economic terms.

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No major role of norepinephrine transporter gene variations in the cardiostimulant effects of MDMA

Abstract

Purpose

Methylenedioxymethamphetamine (MDMA, ecstasy) is used recreationally and frequently leads to sympathomimetic toxicity. MDMA produces cardiovascular and subjective stimulant effects that were shown to partially depend on the norepinephrine transporter (NET)-mediated release of norepinephrine and stimulation of α₁-adrenergic receptors. Genetic variants, such as single-nucleotide polymorphisms (SNPs), of the NET gene (SLC6A2) may explain interindividual differences in the acute stimulant-type responses to MDMA in humans.

Methods

We characterized the effects of common genetic variants of the SLC6A2 gene (rs168924, rs47958, rs1861647, rs2242446, and rs36029) on cardiovascular and subjective stimulation after MDMA administration in 124 healthy subjects in a pooled analysis of eight double-blind, placebo-controlled studies.

Results

Carriers of the GG genotype of the SLC6A2 rs1861647 SNP presented higher elevations of heart rate and rate-pressure product after MDMA than subjects with one or no G alleles. Subjects with a C allele in the SLC6A2 rs2242446 SNP presented higher elevations of the heart rate after MDMA administration compared with the TT genotype. Subjects with the AA genotype of the SLC6A2 rs36029 SNP presented higher elevations of mean arterial pressure and rate pressure product after MDMA administration than carriers of the G allele. The SLC6A2 rs168924 and rs47958 SNPs did not alter the response to MDMA.

Conclusions

Genetic polymorphisms of the SLC6A2 gene weakly moderated the acute cardiovascular response to MDMA in controlled studies and may play a minor role in adverse cardiovascular events when MDMA is used recreationally.

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Development and pilot testing of PHARAO—a decision support system for pharmacological risk assessment in the elderly

Abstract

Purpose

The aims of this study are to describe the development of PHARAO (Pharmacological Risk Assessment Online), a decision support system providing a risk profile for adverse events, associated with combined effects of multiple medicines, and to present data from a pilot study, testing the use, functionality, and acceptance of the PHARAO system in a clinical setting.

Methods

About 1400 substances were scored in relation to their risk to cause any of nine common and/or serious adverse effects. Algorithms for each adverse effect score were developed to create individual risk profiles from the patient's list of medication. The system was tested and integrated to the electronic medical record, during a 4-month period in two geriatric wards and three primary healthcare centers, and a questionnaire was answered by the users before and after the test period.

Results

A total of 732 substances were tagged with one or more of the nine risks, most commonly with the risk of sedation or seizures. During the pilot, the system was used 933 times in 871 patients. The most common signals generated by PHARAO in these patients were related to the risks of constipation, sedation, and bleeding. A majority of responders considered PHARAO easy to use and that it gives useful support in performing medication reviews.

Conclusions

The PHARAO decision support system, designed as a complement to a database on drug-drug interactions used nationally, worked as intended and was appreciated by the users during a 4-month test period. Integration aspects need to be improved to minimize unnecessary signaling.

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Plasma IL-8 signature correlates with pain and depressive symptomatology in patients with Burning Mouth Syndrome: results from a pilot study.

Plasma IL-8 signature correlates with pain and depressive symptomatology in patients with Burning Mouth Syndrome: results from a pilot study.

J Oral Pathol Med. 2017 Dec 01;:

Authors: Barry A, O'Halloran KD, McKenna JP, McCreary C, Downer EJ

Abstract
BACKGROUND: Burning mouth syndrome (BMS) is a neuropathic orofacial pain condition of unknown aetiology that encompasses intra-oral burning pain without abnormal clinical findings. Psychological, neural and inflammatory processes are associated with BMS pathogenesis. Currently, studies characterising plasma cytokine/chemokine profiles with pain and depression in BMS patients are lacking. Considering that inflammation is associated with the pathophysiology of BMS, and that inflammation is closely associated with pain and depression, we aimed to correlate depressive symptomatology and oral cavity pain with plasma cytokine/chemokine signatures in a cohort of patients with BMS.
METHODS: In the present study, plasma protein levels of Th1 cytokines (IFN-γ, IL-2, IL-12p70, TNF-α), Th2 cytokines (IL-4, IL-10, IL-6, IL-13), and the chemokine IL-8, were assessed in BMS patients (n = 10) and healthy volunteers (n = 10), using pro-inflammatory-10-plex assays. Clinical histories, alongside self-rated oral cavity pain intensities and depressive symptomatology were assessed using a visual analogue scale (VAS) and the 16-item Quick Inventory of Depressive Symptomatology (QIDS-SR16 ) questionnaires, respectively.
RESULTS: We present evidence that BMS is associated with increased depressive symptomatology and enhanced oral cavity pain. Plasma isolated from BMS patients display enhanced expression of the pro-inflammatory chemokine IL-8, when compared to plasma from healthy individuals. Plasma IL-8 signature correlates with pain and depressive symptomatology in the study cohort.
CONCLUSIONS: Overall, these findings indicate that plasma IL-8 profiles are dysregulated in BMS and that modulation of IL-8 production in the disorder may be a tool in the management of BMS symptomatology. This article is protected by copyright. All rights reserved.

PMID: 29194773 [PubMed - as supplied by publisher]

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Oral cancer databases: a comprehensive review.

Oral cancer databases: a comprehensive review.

J Oral Pathol Med. 2017 Nov 29;:

Authors: Sarode GS, Sarode SC, Maniyar N, Anand R, Patil S

Abstract
Cancer database is a systemic collection and analysis of information on various human cancers at genomic and molecular level that can be utilized to understand various steps in carcinogenesis and for therapeutic advancement in cancer field. Oral cancer is one of the leading causes of morbidity and mortality all over the world. The current research efforts in this field are aimed at cancer etiology and therapy. Advanced genomic technologies including microarrays, proteomics, transcrpitomics and gene sequencing development have culminated in generation of extensive data and subjection of several genes and microRNAs that are distinctively expressed and this information is stored in the form of various databases. Extensive data from various resources has brought the need for collaboration and data sharing in order to make effective use of this new knowledge. The current review provides comprehensive information of various publicly accessible databases that contain information pertinent to oral squamous cell carcinoma (OSCC) and databases designed exclusively for OSCC. The databases discussed in the present paper are Protein-Coding Gene Databases and microRNA Databases. This paper also describes gene overlap in various databases, which will help researchers to reduce redundancy and focus on only those genes, which are common to more than one databases. We hope such introduction will promote awareness and facilitate the usage of these resources in the cancer research community and researchers can explore the molecular mechanisms involved in the development of cancer, which can help in subsequent crafting of therapeutic strategies. This article is protected by copyright. All rights reserved.

PMID: 29193424 [PubMed - as supplied by publisher]

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Prediction and prevention of allergy and asthma in EAACI journals (2016)

The European Academy of Allergy and Clinical Immunology (EAACI) owns three journals: Allergy, Pediatric Allergy and Immunology and Clinical and Translational Allergy. One of the major goals of EAACI is to supp...

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Social participation for people with communication disability in coffee shops and restaurants is a human right

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Communication as a human right: Citizenship, politics and the role of the speech-language pathologist

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Phase 2 study of intermittent pulse dacomitinib in patients with advanced non-small cell lung cancers.

Phase 2 study of intermittent pulse dacomitinib in patients with advanced non-small cell lung cancers.

Lung Cancer. 2017 Oct;112:195-199

Authors: Yu HA, Ahn MJ, Cho BC, Gerber DE, Natale RB, Socinski MA, Giri N, Quinn S, Sbar E, Zhang H, Giaccone G

Abstract
BACKGROUND: Dacomitinib is a second-generation, irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI). Pre-clinical data suggest that intermittent pulsatile dosing of dacomitinib may result in inhibition of EGFR T790M.
METHODS: We evaluated safety, pharmacokinetics and efficacy of intermittent pulsatile dacomitinib in both molecularly unselected patients and patients with lung cancers harboring EGFR T790M (Clinical Trial Registration Number NCT01858389).
RESULTS: Thirty-eight patients were treated on study with pulse dacomitinib; sixteen with EGFR T790M in Cohort A and 22 who were not molecularly selected in Cohort B. One patient out of 16 patients in Cohort A had a partial response to study therapy (ORR 6.3%, 95% CI 0.2-30.2%). The median progression-free survival (PFS) in Cohort A was 2.3 months and median PFS in Cohort B was 1.6 months. The adverse event profile was similar to standard daily dose dacomitinib with the most frequent treatment-related toxicities occurring in >20% of patients being diarrhea, rash, stomatitis, nausea, dry skin, paronychia, fatigue, and decreased appetite.
CONCLUSION: Intermittent pulsatile dacomitinib is safe and relatively well tolerated but is not effective in patients that harbor EGFR T790M or in unselected patients with non-small cell lung cancer.

PMID: 29191595 [PubMed - in process]

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Exploring Snapchat as a dynamic capture tool for social networking in persons with aphasia

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Anomia for musical entities

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Is past life regression therapy ethical?

Past life regression therapy is used by some physicians in cases with some mental diseases. Anxiety disorders, mood disorders, and gender dysphoria have all been treated using life regression therapy by some doctors on the assumption that they reflect problems in past lives. Although it is not supported by psychiatric associations, few medical associations have actually condemned it as unethical. In this article, I argue that past life regression therapy is unethical for two basic reasons. First, it is not evidence-based. Past life regression is based on the reincarnation hypothesis, but this hypothesis is not supported by evidence, and in fact, it faces some insurmountable conceptual problems. If patients are not fully informed about these problems, they cannot provide an informed consent, and hence, the principle of autonomy is violated. Second, past life regression therapy has the great risk of implanting false memories in patients, and thus, causing significant harm. This is a violation of the principle of non-malfeasance, which is surely the most important principle in medical ethics.

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Resilience of the Oral Microbiota in Health: Mechanisms That Prevent Dysbiosis.

Resilience of the Oral Microbiota in Health: Mechanisms That Prevent Dysbiosis.

J Dent Res. 2017 Nov 01;:22034517742139

Authors: Rosier BT, Marsh PD, Mira A

Abstract
Dental diseases are now viewed as a consequence of a deleterious shift in the balance of the normally stable resident oral microbiome. It is known that frequent carbohydrate consumption or reduced saliva flow can lead to caries, and excessive plaque accumulation increases the risk of periodontal diseases. However, when these "disease drivers" are present, while some individuals appear to be susceptible, others are more tolerant or resilient to suffering from undesirable changes in their oral microbiome. Health-maintaining mechanisms that limit the effect of disease drivers include the complex set of metabolic and functional interrelationships that develop within dental biofilms and between biofilms and the host. In contrast, "positive feedback loops" can develop within these microbial communities that disrupt resilience and provoke a large and abrupt change in function and structure of the ecosystem (a microbial "regime shift"), which promotes dysbiosis and oral disease. For instance, acidification due to carbohydrate fermentation or inflammation in response to accumulated plaque select for a cariogenic or periopathogenic microbiota, respectively, in a chain of self-reinforcing events. Conversely, in tolerant individuals, health-maintaining mechanisms, including negative feedback to the drivers, can maintain resilience and promote resistance to and recovery from disease drivers. Recently studied health-maintaining mechanisms include ammonia production, limiting a drop in pH that can lead to caries, and denitrification, which could inhibit several stages of disease-associated positive feedback loops. Omics studies comparing the microbiome of, and its interaction with, susceptible and tolerant hosts can detect markers of resilience. The neutralization or inhibition of disease drivers, together with the identification and promotion of health-promoting species and functions, for example, by pre- and probiotics, could enhance microbiome resilience and lead to new strategies to prevent disease.

PMID: 29195050 [PubMed - as supplied by publisher]

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The implication of probiotics in the prevention of dental caries.

The implication of probiotics in the prevention of dental caries.

Appl Microbiol Biotechnol. 2017 Nov 30;:

Authors: Lin TH, Lin CH, Pan TM

Abstract
The current oral health crisis, whose causes are varied and complex, necessitates timely oral evaluation and early detection and treatment of oral health problems. Dramatic changes in eating habits and lifestyles are associated with the recent decline in oral health. Probiotics are "good" bacteria that support digestion and a healthy immune system and offer various health benefits to the host. Traditionally, probiotics have been used to improve gut health; the most common uses have historically been as a treatment or prevention of gastrointestinal infections and disease. During the last decade, studies have additionally suggested the intake of probiotics for oral health purposes. Probiotic use provides an effective strategy to combat oral disease, including the development of dental caries and periodontal infection. The aim of this review is to describe the beneficial roles of probiotic bacteria in the oral cavity and the potential mechanisms by which these bacteria exert their effects on oral health.

PMID: 29192351 [PubMed - as supplied by publisher]

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Prevalence of severe early childhood caries and associated socioeconomic and behavioral factors in Xinjiang, China: a cross-sectional study

Abstract

Background

This study assessed the prevalence and severity of early childhood caries (ECC) and identified socioeconomic and behavioral correlates of the disease in preschool children living in Xinjiang.

Methods

For this cross-sectional survey, 1727 children aged 3–5 years in Xinjiang were randomly recruited using a three-stage cluster sampling procedure. The "dmft" index according to the WHO 1997 criteria was used to assess ECC and severe ECC (S-ECC). A questionnaire was completed by caregivers. Variables included sociodemographic characteristics, dietary and oral hygiene behaviors, and access to dental services. The statistical associations of variables with ECC, S-ECC, and dmft were evaluated by univariate and multiple logistic regression analyses.

Results

The prevalence of ECC was 78.2% and that of S-ECC was 41.2%; mean dmft scores were 5.61 ± 3.56 and 8.17 ± 2.94, respectively. The prevalence of ECC was significantly higher in children from Ining (OR 2.747; 95% CI 2.033–3.713), those whose caregivers had caries (OR 1.78; 95% CI 1.245–2.547), those with a dental visit in the past (OR 2.023; 95% CI 1.429–2.865), and those whose parents had received instructions on oral health care (OR 2.171; 95% CI 1.44–3.272), and increased significantly at age 4 years (OR 2.09; 95% CI 1.506–2.901) and 5 years (OR 2.666; 95% CI 1.855–3.833) and in children who starting tooth brushing at a young age (OR 1.363; 95% CI 1.171–1.587), and decreased significantly in children with a more educated mother (OR 0.817; 95% CI 0.688–1), those from high-income families (OR 0.667; 95% CI 0.582–0.765), those with low consumption of sweets (OR 0.66; 95% CI 0.57–0.763), and those who seldom ate before sleep (OR 0.557; 95% CI 0.437–0.712).

Conclusions

ECC and S-ECC remain a serious problem among preschool children in Xinjiang. Caries rates were associated with sociodemographic and behavioral factors, which could be modified by public health strategies, including protection of primary dentition, extension of insurance to cover oral preventive services, improvement of the oral health care system, and public health education.

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Cohort Profile: The Heinz C. Prechter Longitudinal Study of Bipolar Disorder

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The association between asthma and type 1 diabetes: a paediatric case-cohort study in Finland, years 1981–2009

Abstract

Background

The association between asthma and type 1 diabetes, two chronic, immune-mediated diseases, has been of longstanding interest, but the evidence is still conflicting. We examined this association in a large, nationwide case-cohort study among Finnish children, using a novel statistical approach.

Methods

Among the initial cohort of all children born between 1 January 1981 and 31 December 2008, those who were diagnosed with asthma (n = 81 473) or type 1 diabetes (n = 9541) up to age 16 years by the end of 2009 were identified from the Central Drug Register maintained by the Social Insurance Institution of Finland. A 10% random sample from each initial birth year cohort was selected as a reference cohort (n = 171 138). The association between asthma and type 1 diabetes was studied using a multistate modelling approach to estimate transition rates between healthy and disease states since birth. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to represent the change in the transition rate between the disease states.

Results

After adjusting for sex and birth decade, previous diagnosis of asthma increased the risk of subsequent type 1 diabetes by 41% (95% CI: 1.28, 1.54), whereas previous diagnosis of type 1 diabetes decreased the risk of subsequent asthma by 18% (95% CI: 0.69, 0.98).

Conclusions

The findings of the present study imply that the association between the diseases is more complex than previously thought, and its direction depends on the sequential appearance of the diseases.

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Dentist treats AIDS patients through the decades

"They would say, 'okay, but you can't let anybody know.' And I said, 'what do you mean you can't let people know? That's stupid.

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Orofacial Pain and Temporomandibular Disorders Classification Systems: A critical appraisal and future directions

Summary

It is a difficult undertaking to design a classification system for any disease entity, let alone for orofacial pain (OFP) and more specifically for temporomandibular disorders (TMD). A further complication of this task is that both physical and psychosocial variables must be included. In order to augment this process a two step systematic review, adhering to PRISMA guidelines, of the classification systems published during the last 20 years for OFP and TMD was performed. The first search step identified 190 potential citations which ultimately resulted in only 17 articles being included for in depth analysis and review. The second step resulted in only 5 articles being selected for inclusion in this review. Five additional articles and four classification guidelines/criteria were also included due to expansion of the search criteria. Thus, in total, 14 documents comprising articles and guidelines/criteria (8 proposals of classification systems for OFP; 6 for TMD) were selected for inclusion in the systematic review. For each, a discussion as to their advantages, strengths and limitations was provided. Suggestions regarding the future direction for improving the classification process with the use of ontological principles rather than taxonomy are discussed. Furthermore, the potential for expanding the scope of axes included in existing classification systems, to include genetic, epigenetic and neurobiological variables, is explored. It is therefore recommended that future classification system proposals be based on combined approaches aiming to provide archetypal treatment-oriented classifications.

This article is protected by copyright. All rights reserved.

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Long-term variability of sleep bruxism and psychological stress in patients with jaw-muscle pain: report of two longitudinal clinical cases

Abstract

Background

Sleep bruxism (SB) and psychological stress are commonly considered as contributing factors in the etiology of temporomandibular disorder (TMD) pain. However the lack of longitudinal studies and fluctuating nature of SB, psychological stress and TMD-pain have led to contradictory results regarding the association between the possible etiological factors and TMD-pain.

Objective

The purpose of this study was to determine the contribution of SB and psychological stress to TMD-pain in a longitudinal study of two clinical TMD-pain cases during a 6-week study-protocol.

Methods

Two female volunteers with clinically diagnosed myalgia based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) participated in the study. Questionnaires were used to record jaw-muscle pain and psychological stress experience, and an ambulatory polysomnography technique was used to record SB intensity.

Results

Visual analysis of the data revealed that the intensity of TMD-pain was not hardwired, neither with psychological stress experience nor with increased SB activity.

Conclusion

Within the limitations of single-patient clinical cases design, our study suggested that the presence of TMD-pain cannot be explained by a simple linear model which takes psychological stress or SB into account. It also seems that psychological stress was a more important predictor factor for TMD-pain than SB.

This article is protected by copyright. All rights reserved.

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Evaluation of swallowing ability using swallowing sounds in maxillectomy patients

Abstract

Maxillectomy for oral tumors often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0±12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9±21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. DPI was significantly longer in maxillectomy patients without their obturator than with it (p<0.05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (p<0.025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (p<0.05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement.

This article is protected by copyright. All rights reserved.

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Immunohistopathological characterization and the impact of topical immunomodulatory therapy in oral chronic GVHD: a pilot study

Abstract

Objective

To characterize the immunohistopathologic features of oral chronic graft-versus-host disease (cGVHD), and the impact of topical immunomodulatory therapy on the infiltrating cells.

Material And Methods

Paired oral cGVHD biopsies obtained before (n=12) and one month after treatment (n=12) with topical dexamethasone (n=8) or tacrolimus (n=4) were characterized by immunohistochemistry using a panel of CD1a, CD3, CD4, CD8, CD20, CD31, CD62E, CD103, CD163, c-kit and FoxP3. Controls included acute GVHD (aGVHD; n=3), oral lichen planus (OLP; n=5) and normal tissues (n=5).

Results

Oral cGVHD specimens prior to treatment were mainly characterized by basal cell squamatization, lichenoid inflammation, sclerosis, apoptosis, and lymphocytic exocytosis. The infiltrating cells in oral cGVHD primarily consisted of CD3⁺, CD4⁺, CD8⁺, CD103⁺, CD163⁺ and FoxP3⁺ cells, which were higher than in normal tissues. Topical dexamethasone or tacrolimus reduced neutrophilic exocytosis, basal cell squamatization and lichenoid inflammation in oral cGVHD, and dexamethasone reduced the number of CD4⁺ and CD103⁺ cells.

Conclusion

The high expression of CD3, CD4, CD8, CD103, CD163 and FoxP3 confirms that oral cGVHD is largely T cell driven with macrophage participation. The impact of topical immunomodulatory therapy was variable, reducing histological inflammatory features, but with a weak clinicopathological correlation. Topical dexamethasone reduced the expression of CD4 and CD103, which may offer novel therapeutic targets.

This article is protected by copyright. All rights reserved.

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CD29 is highly expressed on epithelial, myoepithelial and mesenchymal stromal cells of human salivary glands

Abstract

Objective

The phenotype of the cells present in the ductal region of salivary glands have been well characterized. However, it is imperative to identify novel biomarkers that can identify different cell types present in other glandular components for the development of therapeutic strategies and diagnostics of salivary gland disorders and malignancies. Our study aimed at the characterization of the expression and distribution of various cell surface markers, especially with a focus on CD29 in human fetal as well as adult glands.

Materials and methods

Paired human midgestation fetal and adult parotid, sublingual and submandibular glands were collected. Phenotypic expression of various lineage-specific cell surface markers including CD29 was investigated in freshly collected glands. The findings were further corroborated by immunohistochemistry assay.

Results

Enriched expression of CD29 was found on acinar and ductal epithelial, mesenchymal stromal and myoepithelial cells; CD29⁺ cells co-expressed epithelial (CD324, CD326, NKCC1 and CD44), mesenchymal (CD73, CD90, vimentin and CD34) and myoepithelial (α-SMA) cell-specific progenitor markers in both fetal as well as adult salivary glands.

Conclusion

CD29 is widely expressed in human salivary glands and, it could serve as a potential biomarker for devising novel cellular therapeutic and diagnostic strategies for salivary gland disorders and malignancies.

This article is protected by copyright. All rights reserved.

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A Phenolic Acid and Flavonoid Fraction Isolated from Lolium multiflorum Lam. Prevents d -Galactosamine-Induced Liver Damages through the Augmentation of Nrf2 Expression

Abstract

The aims of this study were to explore whether a phenolic acid and flavonoid fraction (named PAFF) isolated from Lolium multiflorum Lam. protects against d-galactosamine (GalN)-induced liver damages in mice and to investigate the associated mechanisms. ICR mice received oral administration with various concentrations (50, 100, and 200 mg/kg body weight) of PAFF once per 2 days for seven times before intraperitoneal injection with 800 mg/kg GalN. After a day of GalN challenge, blood and tissue samples were analyzed by biochemical, histopathological, real time RT-PCR, and Western blot methods. GalN challenge induced severe damage to hepatocytes with hepatocellular vacuolization and necrosis. GalN treatment increased serum ALT, ALP, AST, and LDH levels and hepatic MDA levels and stimulated mRNA and protein expressions of Nrf2 and HO-1 in the liver. GalN treatment also diminished the levels of GSH and the activities of CAT, SOD, and GPx in the liver. However, combined treatment with PAFF inhibited GalN-mediated increases in the histological damages and the levels of serum enzymes and hepatic MDA, restored the activities of hepatic antioxidant enzymes up to those in the control values, and augmented the GalN-stimulated expression of Nrf2 and HO-1 in the liver. Furthermore, PAFF treatment alone increased the cellular SOD activity and the expression of Nrf2 and HO-1 in the liver. Our results suggest that PAFF may protect against GalN-induced liver damage by decreasing oxidative stress and increasing cellular antioxidant activities through an activation of Nrf2/HO-1-dependent pathway.

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Effects of nutraceuticals on anaplastic thyroid cancer cells

Abstract

Purpose

The anaplastic thyroid carcinoma (ATC) is the most aggressive thyroid cancer with a high mortality rate. Since nutraceuticals may exert beneficial effects on tumor biology, here, effects of four of these compounds [resveratrol, genistein, curcumin and epigallocatechin-3-gallate (EGCG)] on ATC cell lines were investigated.

Methods

Two ATC-derived cell lines were used: SW1736 and 8505C. Cell viability and in vitro aggressiveness was tested by MTT and soft agar assays. Apoptosis was investigated by Western Blot, using an anti-cleaved-PARP antibody. mRNA and miRNA levels were quantified by real-time PCR.

Results

All tested nutraceuticals caused in both cell lines decrease of cell viability and increase of apoptosis. In contrast, only curcumin reduced in vitro aggressiveness in both SW1736 and 8505C cell lines, while genistein and EGCG determined a reduction of colony formation only in 8505C cells. Effects on genes related to the thyroid-differentiated phenotype were also tested: resveratrol and genistein administration determined the increment of almost all tested mRNAs in both cell lines. Instead curcumin and EGCG treatments had opposite effects in the two cell lines, causing the increment of almost all the mRNAs in 8505C cells and their reduction in SW1736. Finally, effects of nutraceuticals on levels of several miRNAs, known as important in thyroid cancer progression (hsa-miR-221, hsa-miR-222, hsa-miR-21, hsa-miR-146b, hsa-miR-204), were tested. Curcumin induced a strong and significant reduction of all miR analyzed, except for has-miR-204, in both cell lines.

Conclusions

Altogether, our results clearly indicate the anti-cancer proprieties of curcumin, suggesting the promising use of this nutraceutical in ATC treatment. Resveratrol, genistein and EGCG have heterogeneous effects on molecular features of ATC cells.

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Goodness Dental Selected as Exclusive Dental Partner of Soter Healthcare

Best Dental Clinic in Costa Rica & Guatemala for Dental Implants, All on Four & Full Mouth Restorations Chosen as Exclusive Dental Partner by US Firm. While there are many very good dental clinics in Costa Rica and Guatemala...Goodness Dental is unique in their approach to patient care & the results are proof positive that their approach is a winner" NEW YORK, NY, USA, December 1, 2017 / EINPresswire.com / -- Soter Healthcare, a globally-recognized leader in medical tourism and destination healthcare announced the selection of Goodness Dental in Costa Rica and Guatemala as Soter's exclusive dental partner in those countries.

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