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The Journal of Clinical Pediatric... 2018To compare dental caries and oral findings in patients affected by different types of Cerebral Palsy (CP). (Comparative Study)
Comparative Study
OBJECTIVE
To compare dental caries and oral findings in patients affected by different types of Cerebral Palsy (CP).
STUDY DESIGN
This cross-sectional study involved 120 children and adolescents with a diagnosis of CP. WHO diagnostic criteria were used to determine DMFT (caries diagnosis), the pocket depth and attachment level (periodontitis diagnosis). Additionally, the study evaluated dental erosion, traumatic dental injuries, treatment needs index (TNI), oral habits, malocclusions, gingival overgrowth, and dental fluorosis.
RESULTS
The most frequent CP type was spastic (62.5%), followed by mixed (18.3%), ataxic (10%), and athetoid (9.1). Patients affected by mixed CP showed a higher prevalence in decayed, DMFT index and TNI compared with the other types of CP (p<0.05). The frequency of malocclusion in the clinical evaluation was 87.5% and in plaster models was 49.2%.
CONCLUSIONS
Dental caries was an important issue in mixed and athetoid CP groups. Oral habits and malocclusions were the most significant oral health problems in individuals with CP.
Topics: Adolescent; Cerebral Palsy; Child; Cross-Sectional Studies; DMF Index; Dental Caries; Female; Humans; Male; Malocclusion; Oral Hygiene
PubMed: 29360427
DOI: 10.17796/1053-4628-42.1.11 -
The Journal of Contemporary Dental... Jan 2018In countries where human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is widespread and highly active antiretroviral therapy (HAART) medications...
INTRODUCTION
In countries where human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is widespread and highly active antiretroviral therapy (HAART) medications are too expensive, or patients are failing HAART, oral disease management and risk remain an important issue.
AIM
The aim of the study was to evaluate the prevalence of oral mucosal lesions and periodontitis among the HIV-positive adult patients and assess the association of these lesions with age, sex, duration of HIV, time on ART, dietary habits, and oral hygiene habits.
MATERIALS AND METHODS
Sample size was 170. Demographic data of the patients along with community periodontal index (CPI) and loss of attachment (LA) were recorded. Oral soft tissue lesions, such as ulcerations, sores, erosions, and fissures were also recorded. The study was carried out in Raichur Taluk, Karnataka, India. Convenience sampling design was followed. Statistical Package for the Social Sciences (SPSS) version 20.0 (Chicago, USA) was used for data analysis. Chi-square test was carried out; p < 0.05 was considered to be statistically significant.
RESULTS
There was no association between the oral mucosal conditions and the age and the adverse habits, such as tobacco and alcohol, CD4 count, and the time duration of HIV and ART among these patients. A higher percentage of people with 4 to 5 mm of pockets was seen with those who cleaned their teeth with a finger, which was statistically significant.
CLINICAL SIGNIFICANCE
The present study highlights the poor condition of the oral health of these patients and their unmet dental needs.
Topics: Adult; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Cross-Sectional Studies; Female; HIV Infections; Humans; India; Male; Mouth Diseases; Oral Health; Periodontal Index; Periodontitis; Prevalence
PubMed: 29358533
DOI: 10.5005/jp-journals-10024-2209 -
Acta Cardiologica Sinica Jul 2017Cardiac device-related infective endocarditis is an uncommon but potentially fatal complication. Therefore, cardiac devices should be removed as soon as a device-related...
BACKGROUND
Cardiac device-related infective endocarditis is an uncommon but potentially fatal complication. Therefore, cardiac devices should be removed as soon as a device-related infection is suspected.
CASE REPORT
A 56-year-old male with a history of arrhythmogenic right ventricular dysplasia with implantable cardioverter-defibrillators (ICDs) 7 years earlier and re-implantation of ICDs due to dysfunction 18 months ago presented with erosion of the ICD pocket with Pseudomonas bacteremia. For the past year, only multiple wound debridements were performed. Accordingly, we performed debridement and removal of the generator during this admission; however, bacteremia still persisted. Using transesophageal echocardiography, we detected vegetation on the pacing leads and tricuspid valve in the right atrium. We performed thoracotomy with tricuspid valve repair and pacing wire removal. However, anterior chest pain and refractory bacteremia occurred 3 months later after discharge, and an infectious foreign body in the wall of the innominate vein was detected using chest computer tomography. Thoracotomy was again performed for resection of the innominate vein with the infection source. Postoperative recovery was good, with no systemic infection or bacteremia.
CONCLUSIONS
Pacing lead extraction is a common procedure following cardiac rhythm management device-related infection. However, residual foreign body-related bacteremia should be suspected in cases with fever of unknown origin after primary surgery. Preserving the innominate vein with patch repair is a feasible option. However, a postoperative 4-week course of antibiotics is recommended.
PubMed: 29033518
DOI: 10.6515/acs20160911a -
Seminars in Ophthalmology 2018Understanding the evolution of complications after scleral-fixated lens placement demonstrates advantageous surgical techniques and suitable candidates. (Review)
Review
INTRODUCTION
Understanding the evolution of complications after scleral-fixated lens placement demonstrates advantageous surgical techniques and suitable candidates.
MATERIALS/METHODS
A literature search in PubMed for several terms, including "scleral intraocular lens complication," yielded 17 relevant articles.
RESULTS
Reviewing complication trends over time, lens tilt and suture erosion have decreased, cystoid macular edema has increased, and retinal detachment has remained the same after scleral-fixated lens placement. The successful reduction in complications are attributed to several alterations in technique, including positioning sclerotomy sites 180 degrees apart and using scleral flaps or pockets to bury sutures. Possible reduction in retinal risks have been proposed by performing an anterior vitrectomy prior to lens placement in certain settings.
DISCUSSION
Complications after scleral-fixated lens placement should assist patient selection. Elderly patients with a history of hypertension should be counseled regarding risk of suprachoroidal hemorrhage, while young patients and postocular trauma patients should be considered for concurrent anterior vitrectomy.
Topics: Aphakia, Postcataract; Humans; Lenses, Intraocular; Postoperative Complications; Sclera; Suture Techniques; Sutures
PubMed: 28898111
DOI: 10.1080/08820538.2017.1353808 -
Operative Neurosurgery (Hagerstown, Md.) Aug 2017Deep brain stimulation is increasingly used to treat a variety of disorders. As the prevalence of this technology increases, greater demands are placed on neurosurgical...
BACKGROUND
Deep brain stimulation is increasingly used to treat a variety of disorders. As the prevalence of this technology increases, greater demands are placed on neurosurgical practitioners to improve cosmetic results, maximize patient comfort, and minimize complication rates. We have increasingly employed subpectoral implantation of internal pulse generators (IPGs) to improve patient satisfaction.
OBJECTIVE
To determine the complication rates of subpectorally placed IPGs as compared to those placed in a subcutaneous location.
METHODS
We reviewed a series of 301 patients from a single institution. Complication rates including infection, hematoma, and lead fracture were recorded. Rates were compared for subcutaneously and subpectorally located devices.
RESULTS
Of the records reviewed, we found 301 patients who underwent 308 procedures for initial IPG implantation. Of these, 275 were subpectoral IPG implantation, 19 were infraclavicular subcutaneous implantation, and 14 were subcutaneous implantation in the abdomen. A total of 6 IPG pocket infections occurred, 2 subpectoral and 4 infraclavicular subcutaneous. Of the IPG infections, 2 of the infraclavicular subcutaneous devices had associated erosions. Two patients had their devices relocated from a subpectoral pocket to a subcutaneous pocket in the abdomen due to discomfort. Two patients in the subpectoral group suffered from hematoma requiring evacuation. Two patients in the infraclavicular subcutaneous group had lead fracture occur.
CONCLUSIONS
Subpectoral implantation of deep brain stimulation IPGs is a viable alternative with a low complication rate. This technique may offer a lower rate of infection and wound erosion.
Topics: Aged; Cosmetics; Deep Brain Stimulation; Electric Power Supplies; Electrodes, Implanted; Essential Tremor; Female; Humans; Longitudinal Studies; Male; Middle Aged; Parkinson Disease; Patient Satisfaction; Pectoralis Muscles; Retrospective Studies; Treatment Outcome
PubMed: 28838110
DOI: 10.1093/ons/opx018 -
Artificial Cells, Nanomedicine, and... Sep 2018Periodontal disease is chronic, highly prevalent infectious disease that requires prolonged and controlled delivery of antimicrobial agents into pockets. To achieve this...
Periodontal disease is chronic, highly prevalent infectious disease that requires prolonged and controlled delivery of antimicrobial agents into pockets. To achieve this objective, dual antimicrobials encapsulated chitosan fortified calcium alginate (CS-Ca-SA) microspheres were formulated by application of Plackett-Burman factorial design. The microspheres were optimized for particle size (PS), entrapment efficiency (EE) and drug release. The optimized microspheres presented average PS of 74-461 µm and EE of 62.45-86.20% with controlled drug delivery for 120 hours. FTIR disclosed successful complexation between SA and CS. DSC and XRD studies showed changes in the crystallinity of drugs in microspheres. Shape factor and SEM demonstrated spherical to pear-shaped microspheres. Release exponent >0.43 and high diffusion coefficients revealed non-Fickian-based diffusion-limited drug release. CS-Ca-SA microspheres exhibited surface pH of 6.5 ± 0.5, moderate swelling, less erosion and improved mucoadhesion over Ca-SA microspheres. Also, significant antimicrobial activity against Escherichia coli and Staphylococcus aureus and cytocompatibility with L929 cell lines were observed. Further, microspheres exhibited long-term stability on refrigeration. The outcomes of study supported the potential of dual polymer and dual drug-based biodegradable, stable, non-toxic, mucoadhesive, controlled and prolonged drug release microspheres as more patient compliant by administration into periodontal pockets for the management of periodontal disease.
Topics: Alginates; Anti-Infective Agents; Chitosan; Delayed-Action Preparations; Diffusion; Doxycycline; Drug Carriers; Drug Combinations; Drug Delivery Systems; Drug Liberation; Glucuronic Acid; Hexuronic Acids; Microbial Sensitivity Tests; Microbial Viability; Microspheres; Models, Chemical; Ornidazole; Particle Size
PubMed: 28830256
DOI: 10.1080/21691401.2017.1366331 -
Epilepsy Research Sep 2017Minimally-invasive approaches are needed for long-term reliable Electroencephalography (EEG) recordings to assist with epilepsy diagnosis, investigation and more...
OBJECTIVE
Minimally-invasive approaches are needed for long-term reliable Electroencephalography (EEG) recordings to assist with epilepsy diagnosis, investigation and more naturalistic monitoring. This study compared three methods for long-term implantation of sub-scalp EEG electrodes.
METHODS
Three types of electrodes (disk, ring, and peg) were fabricated from biocompatible materials and implanted under the scalp in five ambulatory ewes for 3months. Disk electrodes were inserted into sub-pericranial pockets. Ring electrodes were tunneled under the scalp. Peg electrodes were inserted into the skull, close to the dura. EEG was continuously monitored wirelessly. High resolution CT imaging, histopathology, and impedance measurements were used to assess the status of the electrodes at the end of the study.
RESULTS
EEG amplitude was larger in the peg compared with the disk and ring electrodes (p<0.05). Similarly, chewing artifacts were lower in the peg electrodes (p<0.05). Electrode impedance increased after long-term implantation particularly for those within the bone (p<0.01). Micro-CT scans indicated that all electrodes stayed within the sub-scalp layers. All pegs remained within the burr holes as implanted with no evidence of extrusion. Eight of 10 disks partially eroded into the bone by 1.0mm from the surface of the skull. The ring arrays remained within the sub-scalp layers close to implantation site. Histology revealed that the electrodes were encapsulated in a thin fibrous tissue adjacent to the pericranium. Overlying this was a loose connective layer and scalp. Erosion into the bone occurred under the rim of the sub-pericranial disk electrodes.
CONCLUSIONS
The results indicate that the peg electrodes provided high quality EEG, mechanical stability, and lower chewing artifact. Whereas, ring electrode arrays tunneled under the scalp enable minimal surgical techniques to be used for implantation and removal.
Topics: Animals; Artifacts; Biocompatible Materials; Bone Diseases; Electric Impedance; Electrodes, Implanted; Electroencephalography; Equipment Design; Female; Mastication; Minimally Invasive Surgical Procedures; Models, Animal; Scalp; Sheep, Domestic; Skull; Wireless Technology; X-Ray Microtomography
PubMed: 28618377
DOI: 10.1016/j.eplepsyres.2017.06.003 -
Otolaryngologia Polska = the Polish... Feb 2017This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and...
This manuscript intends to review types, pathogenesis, associated risk factors, and potential methods of prevention and treatment of the retraction pockets in adults and children. The importance of retraction pockets (RP) lies in loss of original histological and anatomical structure which is associated with development of ossicular chain erosion, cho¬lesteatoma formation and potentially life threatening complications of cholesteatoma. The trans-mucosal exchange each gas in the middle ear (ME) is towards equalizing its partial pressures with the partial pressure in the environ¬ment. MEs that have abnormalities in the volume and ventilation pathways in the epitympanic may be more suscep¬tible to retraction pockets. Sustained pressure differences and/or inflammation leads to destruction of collagen fibers in the lamina propria. Inflammatory mediators and cytokines lead to release of collagenases result in viscoelastic properties of the lamina propria. The process of changes in the tympanic membrane structure may evolve to the cho¬lesteatoma formation. There are many different staging systems that clinicians prioritize in their decision making in the management of RP. The authors discuss the management possibilities in different clinical situations: RP without and with ongoing or intermittent evidence of Eustachian Tube Dysfunction (ETD), presence of adenoid hypertrophy or re-growth of adenoids, presence or absence of effusion, invisible depth of RP without effusion. invisible depth of RP with effusion, ongoing RP after VT insertion, and finally suspicion of cholesteatoma in a deep RP with ME effusion. A decision algorithm regarding the management of TM retraction and retraction pockets is provided.
Topics: Adult; Child; Cholesteatoma, Middle Ear; Eustachian Tube; Hearing Loss, Conductive; Humans; Tympanic Membrane
PubMed: 28485292
DOI: 10.5604/01.3001.0009.5547 -
Diseases of the Esophagus : Official... May 2017In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some... (Meta-Analysis)
Meta-Analysis Review
In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.
Topics: Adult; Alginates; Antacids; Female; Gastroesophageal Reflux; Glucuronic Acid; Hexuronic Acids; Histamine H2 Antagonists; Humans; Male; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 28375448
DOI: 10.1093/dote/dow020 -
Archives of Plastic Surgery Jan 2017Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems,...
BACKGROUND
Skin erosion is a dire complication of implantable cardiac pacemakers and defibrillators. Classical treatments involve removal of the entire generator and lead systems, however, these may result in fatal complications. In this study, we present our experience with a simplified salvage technique for exposed implantable cardiac electronic devices (ICEDs) without removing the implanted device, in an attempt to reduce the risks and complication rates associated with this condition.
METHODS
The records of 10 patients who experienced direct ICED exposure between January 2012 and December 2015 were retrospectively reviewed. The following surgical procedure was performed in all patients: removal of skin erosion and capsule, creation of a new pocket at least 1.0-1.5 cm inferior to its original position, migration of the ICED to the new pocket, and insertion of closed-suction drainage. Patients with gross local sepsis or septicemia were excluded from this study.
RESULTS
Seven patients had cardiac pacemakers and the other 3 had implantable cardiac defibrillators. The time from primary ICED placement to exposure ranged from 0.3 to 151 months (mean, 29 months. Postoperative follow-up in this series ranged from 8 to 31 months (mean follow-up, 22 months). Among the 10 patients, none presented with any signs of overt infection or cutaneous lesions, except 1 patient with hematoma on postoperative day 5. The hematoma was successfully treated by surgical removal and repositioning of the closed-suction drainage.
CONCLUSIONS
Based on our experience, salvage of exposed ICEDs is possible without removing the device in selected patients.
PubMed: 28194346
DOI: 10.5999/aps.2017.44.1.42