Κυριακή 26 Ιουνίου 2022

Complications of sinus floor elevation procedure and management strategies: A systematic review

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Abstract

Aim

This systematic review aimed to investigates the types and incidences of complications following sinus floor elevations (SFE) along with their prevention and management strategies.

Materials and methods

Electronic database and hand search were conducted to screen the literature published from January 1960 to June 2021. The selected studies had to report well-described SFE techniques, complications during, and post-SFE. Data extraction included types of SFE techniques, complications, and their treatment strategies.

Results

A total of 74 studies with 4411 SFE procedures met the inclusion criteria. Different SFE techniques demonstrated varying patterns for both complications and complication rates. Postoperative pain, swelling, and edema were widely reported. The most common complications that required intervention following Lateral SFE (LSFE) were sinus membrane perforation (SMP), wound dehiscence, graft exposure and failure, and sinusitis. LSFE had more SMPs and sinusitis cases compared with a transcrestal SFE (TSFE). The presence of benign paroxysmal positional vertigo following TSFE was significant in certain selected studies.

Conclusion

Given the inherent limitations, this systematic review showed distinct features of complications in SFE using varying techniques. Treatment planning for these procedures should incorporate strategies to avoid complication occurrence.

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Effect of body weight on bleeding events of aspirin in ischemic stroke or transient ischemic attack patients

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Effect of body weight on bleeding events of aspirin in ischemic stroke or transient ischemic attack patients

Bodyweight and combination with SSRIs are related to bleeding adverse reaction of aspirin. Patients weighted less than 60 kg will be at a higher risk of adverse bleeding events.


Abstract

What is Known and Objectives

Bleeding is the most common adverse reaction to aspirin and can lead to drug discontinuation or even be life-threatening in the secondary prevention of stroke or transient ischemic attack. The aim of this study was to evaluate risk factors for bleeding adverse reaction of aspirin in ischemic stroke or transient ischemic attack.

Methods

This retrospective analysis included patients treated with aspirin (100 mg) as a secondary prevention for ischemic stroke or transient ischemic attack. The bleeding events that occurred during the first year were collected, including gastrointestinal, skin, nasal cavity, gum, and urinary tract bleeding events. Then, univariate and multivariate logistic regression analyses were used to identify independent factors associated with bleeding events of aspirin.

Results and Discussion

A total of 578 patients were enrolled in this study, and 58 patients developed bleeding during the first year of secondary prevention. Body weight and combination with selective serotonin reuptake inhibitors were found to be significant risk factors for overall bleeding (p = 0.025 and 0.012). Body weight below 60 kg was a risk factor for overall bleeding and gastrointestinal bleeding events.

What is new and conclusion

Patients weighing less than 60 kg were at increased risk of bleeding with 100 mg aspirin for secondary prevention of cerebral infarction transient ischemic attack.

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The role of gastrointestinal pathogen PCR testing in liver transplant recipients hospitalized with diarrhea

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Abstract

Background

Diarrhea is a common symptom among liver transplant (LT) recipients and can result in significant morbidity. The utility of PCR-based multiplex gastrointestinal (GI) pathogen panels in this population is unknown.

Methods

We assessed incidence, predictors, and outcomes of GI PCR positivity among inpatients who underwent stool pathogen testing with the FilmArray multiplex GI PCR panel at our institution within 1 year following LT from April 2015 to December 2019.

Results

112 patients were identified. 14 (12.5%) had a positive PCR for any pathogen. Escherichia coli (= 9) and Norovirus (= 5) were the most common pathogens detected. Recipients with a positive PCR were significantly further from LT (median 74.5 vs 15.5 days, p < 0.01) and tested earlier during hospitalization (median 1.0 vs 9.0 days, p < 0.01). C. difficile was positive in 20.0% of patients with a positive PCR and 11.4% with a negative PCR. CMV viremia was observed in 11.6% of patients, all in the negative PCR group. Following a positive PCR, patients were more likely to have a change in antimicrobial regimen (71.4% vs 28.6%, p = 0.02), a shorter length of stay (median 7.5 vs. 17.5 days, p < 0.01), and a trend toward lower rates of readmission and colonoscopy within 30 days.

Conclusions

In hospitalized LT recipients with diarrhea, GI PCR pathogen identification was associated with the use of targeted antimicrobial therapy and a shorter length of stay. GI PCR testing should be considered early during admission and later in the post-LT period.

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Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: a controlled clinical study

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Abstract

Background

Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion.

Objectives

To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study.

Methods

73 adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n=34) followed-up during a 6-months dietary program, and Gastroplasty group (GG; n=39) evaluated immediately before, 3, and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the 4 basic tastes were assessed. Two-way mixed model and sign test were applied.

Results

Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p<0.001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein, and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p<0.05).

Conclusion

After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed.

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Nanobots to eliminate bacteria in root canals – Nano Dentistry

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Nanobots in Root Canal Treatment

With millions of Root Canal Treatments being performed every day across the globe, it is important to make sure that Root Canal Treatment is successful in clearing out the bacteria form the Root canals to achieve the purpose of saving an infected tooth using root canal treatment. Disinfection protocol being used today includes mechanical preparation along with use of chemicals such as Sodium Hypochlorite, Hydrogen Peroxide, Chlorhexidine, etc along with Lasers a nd Ultrasonic devices. If these chemicals fail to penetrate the dentinal tubules, accessory canals, etc, proper disinfection cannot be achieved. This is where Nanobots have come into action in eliminating Bacteria in Root Canals which is being termed as - "Nano Dentistry" According to American association of endodontics over 25 millions of root canals are performed annually, over 90% are successful, remaining 10% failures are due to inadequate decontamination of root canal treatment. The dentinal tubules are very small, and the bacteria reside deep in the tissue. correct techniques are not efficient enough to go all the way inside and kill the bacteria. To address these treatment failures, researchers from the "Indian institute of science and nano robotics" company "Theranautilus"  have demonstrated that nano sized robots (nanobots) can effectively kill bacteria in the dentinal tubules. [caption id="attachment_6922" align="alignnone" width="549"]
Nanobots in Root Canal Treatment

Source - https://www.indiatoday.in/science/story/tiny-nanobots-in-teeth-can-kill-bacteria-help-better-dental-treatment-1950064-2022-05-16[/caption] How do Dental Nanobots work in Root Canal Treatment?  Dental Nanobots work by heating up their surface and in turn killing the bacteria in the canals with which they come in contact. So Nanobots use heat to disinfect the canals without the need for chemicals. According to the findings, nanobots were able to penetrate up to 2000um into dentinal tubules, thus achieving a vast improvement in penetration depth compared to laser activation and ultrasonic devices, researchers believe that using the heat to kill the bacteria is the safe alternative to using harsh chemicals agents or antibiotics to decontaminate a root canal. When the nanobots were injected into extracted tooth samples, the nanobots are penetrated deep inside the the dentinal tubules under the control of device that generates a low intensity magnetic field. By manipulating magnetic field, the researches were able to cause the surface of nanobots to generate heat to kill the bacteria nearby. To this end, researchers are currently developing a novel medical device that can be easily placed inside the patient mouth and allow the dentist to inject and manipulate the nanobots inside the teeth during the root canal therapy. Nanobots Or magnetically controlled nanoparticles have been used to trap and move objects using light, which pass through blood and tend to adhere to cancer cells. Researchers at Theranautilus, have used the dental nanoparticles on mice and have concluded them to be safe for use in Biological tissue. The study, titled "Mobile nanobots for prevention of root canal treatment failure", was published online on 28 April 2022 in Advanced Healthcare Materials, ahead of inclusion in an issue. References - Researchers use nanobots to eliminate bacteria in Root canals - Dental Tribune
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Differential perivascular microglial activation in the deep white matter in vascular dementia developed post‐stroke

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Differential perivascular microglial activation in the deep white matter in vascular dementia developed post-stroke

Post-stroke patients who develop dementia accrued more perivascular activated CD68+ microglia in the frontal white matter (FWM) This implies activated CD68+ cells are responsible for perivascular inflammation within the gliovascular unit of the FWM


Abstract

With the hypothesis that perivascular microglia are involved as neuroinflammatory components of the gliovascular unit contributing to white matter hyperintensities on MRI and pathophysiology, we assessed their status in stroke survivors who develop dementia. Immunohistochemical and immunofluorescent methods were used to assess the distribution and quantification of total and perivascular microglial cell densities in 68 brains focusing on the frontal lobe WM and overlying neocortex in post-stroke dementia (PSD), post-stroke non-dementia (PSND) and similar age control subjects. We primarily used CD68 as a marker of phagocytic microglia, as well as other markers of microglia including Iba-1 and TMEM119, and the myeloid cell marker TREM2 to assess dementia-specific changes. We first noted greater total densities of CD68+ and TREM2+ cells per mm2 in the frontal WM compared to the overlying cortex across the stroke cases and controls (p =&nbs p;0.001). PSD subjects showed increased percentage of activated perivascular CD68+ cells distinct from ramified or primed microglia in the WM (p < 0.05). However, there was no apparent change in perivascular TREM2+ cells. Total densities of TREM2+ cells were only ~10% of CD68+ cells but there was high degree of overlap (>70%) between them in both the WM and the cortex. CD68 and Iba-1 or CD68 and TMEM119 markers were colocalised by ~55%. Within the deep WM, ~30% of CD68+ cells were co-localised with fragments of degraded myelin basic protein. Among fragmented CD68+ cells in adjacent WM of PSD subjects, >80% of the cells expressed cleaved caspase-3. Our observations suggest although the overall repertoire of perivascular microglial cells is not changed in the parenchyma, PSD subjects accrue more perivascular-activated CD68+ microglia rather than TREM2+ cells. This implies there is a subset of CD68+ cells, which are respon sible for the differential response in perivascular inflammation within the gliovascular unit of the deep WM.

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Comparative effectiveness and stage‐shift effect of endoscopic exam among newly diagnosed oral cancer patients with different stages in Taiwan

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Abstract

Background

Patients with oral cancer are at higher risk of developing second primary esophageal cancer (SPEC) and the consensus for screening strategies remains unclear. This study aimed to examine comparative effectiveness and the stage-shift effect of endoscopic exam among patients with oral cancer.

Method

A population-based longitudinal retrospective observational matched case and control cohort study with at least 5 years follow-up was conducted. We identified 45 457 newly diagnosed patients with oral cancer, 2004–2013, and the eligible patient with oral cancer was 39 401. Propensity score matching was used to match comparable groups, and the two groups (screening vs. nonscreening) was 5941, individually. The study primary endpoints were to compare detection of incident SPEC and the stage-shift effect of endoscopic screening between screened and nonscreened incident oral cancer patients. Cox proportional hazard and competing risk models were analyzed. Statistical analyses were conducted in 2020–2021.

Result

Detection of incident SPEC in the screened group was significantly higher than in the nonscreened group (hazard ratio: 2.92, 95% confidence interval [CI]: 2.29–3.72). The stage-shift effect from endoscopic screening was found overall in patients with oral cancer (odds ratio [OR]: 0.39, 95%CI: 0.21–0.70), in particular in advanced-stage patients (OR: 0.25, 95%CI: 0.11–0.61), but not in early-stage patients (OR: 0.60, 95%CI: 0.26–1.40).

Conclusion

This study confirmed that endoscopic screening achieved early detection of SPEC among patients with oral cancer. To improve the screening stage-shift effect, patients with oral cancer are encouraged to undergo routine endoscopic screening.

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