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BMJ Neurology Open 2024Ocrelizumab, a humanised anti-CD20 monoclonal, is a highly effective treatment for relapsing-remitting multiple sclerosis (RRMS). The long-term safety of B-cell...
BACKGROUND
Ocrelizumab, a humanised anti-CD20 monoclonal, is a highly effective treatment for relapsing-remitting multiple sclerosis (RRMS). The long-term safety of B-cell depletion in RRMS, however, is uncertain and there are no data on dose reduction of ocrelizumab as a risk mitigation strategy. This study aimed to evaluate the effectiveness and safety of reducing ocrelizumab dose from 600 to 300 mg in patients with RRMS.
METHOD
Data were collected through the Townsville neurology service. Following the standard randomised controlled trial regimen of 600 mg every 6 months for 2 years, sequential patients consented to dose reduction to 300 mg every 6 months. Patients were included if they were diagnosed with RRMS and received at least one reduced dose of ocrelizumab. Relapse, disability progression, new MRI lesions, CD19 cell counts and immunoglobulin concentrations were analysed.
RESULTS
A total of 35 patients, treated with 177 full and 107 reduced doses, were included. The mean follow-up on reduced dose was 17 (1-31) months. We observed no relapses or new MRI activity in the cohort receiving the reduced dose, accompanied by persistent CD19+B cell depletion (≤0.05×10/L). Mean IgG, IgA and IgM levels remained stable throughout the study. No new safety concerns arose.
CONCLUSIONS
In this single-centre observational study, dose reduction of ocrelizumab from 600 to 300 mg every 6 months after 2 years appeared to maintain efficacy in terms of new inflammatory disease activity. A randomised trial may be warranted to confirm this and explore the impact of dose reduction on long-term safety.
PubMed: 38912173
DOI: 10.1136/bmjno-2024-000672 -
Frontiers in Oncology 2024Pediatric low-grade gliomas (pLGG) are the most common brain tumor in children and encompass a wide range of histologies. Treatment may pose challenges, especially in...
INTRODUCTION
Pediatric low-grade gliomas (pLGG) are the most common brain tumor in children and encompass a wide range of histologies. Treatment may pose challenges, especially in those incompletely resected or those with multiple recurrence or progression.
CASE DESCRIPTION
We report the clinical course of a girl diagnosed with pilocytic astrocytoma and profound hydrocephalus at age 12 years treated with subtotal resection, vinblastine chemotherapy, and focal proton radiotherapy. After radiotherapy the tumor increased in enhancement temporarily with subsequent resolution consistent with pseudoprogression. Despite improvement in imaging and radiographic local control, the patient continues to have challenges with headaches, visual and auditory concerns, stroke-like symptoms, and poor quality of life.
CONCLUSION
pLGG have excellent long-term survival; thus, treatments should focus on maintaining disease control and limiting long-term toxicities. Various treatment options exist including surgery, chemotherapy, targeted agents, and radiation therapy. Given the morbidity associated with pLGG, individualized treatment approaches are necessary, with a multi-disciplinary approach to care focused on minimizing treatment side effects, and promoting optimal quality of life for patients.
PubMed: 38912055
DOI: 10.3389/fonc.2024.1366251 -
Clinical, Cosmetic and Investigational... 2024This case report details a pulp revascularization treatment administered to a mature permanent tooth exhibiting pulp necrosis. A 22-years old female patient complained...
This case report details a pulp revascularization treatment administered to a mature permanent tooth exhibiting pulp necrosis. A 22-years old female patient complained of the recurrence of a sinus tract labial of the maxillary right central incisor; which was tender on biting. Diagnosis of pulp necrosis and symptomatic apical periodontitis. Preoperative periapical and CBCT radiographs showed root with wide apical foramen and large apical radiolucency. Pulp revascularization procedure was performed using 1.3% sodium hypochlorite irrigation, 17% Ethylenediaminetetraacetic acid irrigation, and calcium hydroxide intracanal dressing for 2 weeks. During the last visit, intentional bleeding was induced, collagen matrix was set over the blood clot, 2 mm of mineral trioxide aggregate and glass-ionomer filling was placed. A year of follow-up, the tooth showed no signs or symptoms and responded normally to the sensibility tests. Intra-oral periapical radiograph and the CBCT showed significant reduction in the periapical lesion's size, slight reduction in the apical foramen's size, and hard radiopaque material deposition at the root's middle third.
PubMed: 38912006
DOI: 10.2147/CCIDE.S464214 -
F1000Research 2023Pediatric dental treatment is challenging in patients with early childhood caries. For clinician its difficult to manage child and provide good work at the same time.... (Comparative Study)
Comparative Study
BACKGROUND
Pediatric dental treatment is challenging in patients with early childhood caries. For clinician its difficult to manage child and provide good work at the same time. Its necessity to have the best equipments as well as materials. Nowadays, aesthetics play an important role in managing decayed teeth. Zirconia crown is better option but requires excessive preparation. As Bioflx is newly developed crown and has combined stainless steel and zirconia properties.
AIM
To assess the clinical performance and child and parental satisfaction of Bioflex crowns compared to zirconia and stainless steel crowns.
METHODS
In this comparative study of Bioflx crowns with zirconia and stainless steel crowns, children aged three to seven years old will be selected, and 72 primary teeth requiring crowns will be randomly distributed into three groups, n = 24: Preformed stainless steel crown, control; Preformed Bioflex crown; Preformed zirconia crown. Crowns will be evaluated for recurrent caries, plaque accumulation, restoration failure, gingival status opposing tooth wear, and clinicians and parental satisfaction at zero, three, six, and 12 months.
RESULTS
Bioflx crown will have better clinical as well as parental satisfaction among zirconia and stainless steel crowns.
CONCLUSIONS
The Bioflx crown can be used as an alternative economical esthetic full-coronal restoration for primary teeth.
TRIAL REGISTRATION
CTRI registration number: CTRI/2023/05/052256; Date of registration: May 03, 2023.
PROTOCOL VERSION
Two; Date: April 22, 2023.
Topics: Humans; Zirconium; Stainless Steel; Crowns; Child; Child, Preschool; Parents; Dental Caries; Patient Satisfaction; Male; Female
PubMed: 38911945
DOI: 10.12688/f1000research.133464.2 -
Frontiers in Neuroscience 2024An important challenge in epilepsy is to define biomarkers of response to treatment. Many electroencephalography (EEG) methods and indices have been developed mainly...
OBJECTIVES
An important challenge in epilepsy is to define biomarkers of response to treatment. Many electroencephalography (EEG) methods and indices have been developed mainly using linear methods, e.g., spectral power and individual alpha frequency peak (IAF). However, brain activity is complex and non-linear, hence there is a need to explore EEG neurodynamics using nonlinear approaches. Here, we use the Fractal Dimension (FD), a measure of whole brain signal complexity, to measure the response to anti-seizure therapy in patients with Focal Epilepsy (FE) and compare it with linear methods.
MATERIALS
Twenty-five drug-responder (DR) patients with focal epilepsy were studied before (t1, named DR-t1) and after (t2, named DR-t2) the introduction of the anti-seizure medications (ASMs). DR-t1 and DR-t2 EEG results were compared against 40 age-matched healthy controls (HC).
METHODS
EEG data were investigated from two different angles: frequency domain-spectral properties in δ, θ, α, β, and γ bands and the IAF peak, and time-domain-FD as a signature of the nonlinear complexity of the EEG signals. Those features were compared among the three groups.
RESULTS
The δ power differed between DR patients pre and post-ASM and HC (DR-t1 vs. HC, < 0.01 and DR-t2 vs. HC, < 0.01). The θ power differed between DR-t1 and DR-t2 ( = 0.015) and between DR-t1 and HC ( = 0.01). The α power, similar to the δ, differed between DR patients pre and post-ASM and HC (DR-t1 vs. HC, < 0.01 and DR-t2 vs. HC, < 0.01). The IAF value was lower for DR-t1 than DR-t2 ( = 0.048) and HC ( = 0.042). The FD value was lower in DR-t1 than in DR-t2 ( = 0.015) and HC ( = 0.011). Finally, Bayes Factor analysis showed that FD was 195 times more likely to separate DR-t1 from DR-t2 than IAF and 231 times than θ.
DISCUSSION
FD measured in baseline EEG signals is a non-linear brain measure of complexity more sensitive than EEG power or IAF in detecting a response to ASMs. This likely reflects the non-oscillatory nature of neural activity, which FD better describes.
CONCLUSION
Our work suggests that FD is a promising measure to monitor the response to ASMs in FE.
PubMed: 38911599
DOI: 10.3389/fnins.2024.1401068 -
SSM. Qualitative Research in Health Jun 2024•Various aspects of neighbourhood environments influence recovery from psychosis.•High levels of violence at the neighbourhood level may negatively affect...
•Various aspects of neighbourhood environments influence recovery from psychosis.•High levels of violence at the neighbourhood level may negatively affect recovery.•Social cohesion may be a protective factor that promotes recovery.•Normalisation of cannabis use and easy access to cannabis may also hinder recovery.•Community involvement is needed to design interventions targeting these factors.
PubMed: 38911287
DOI: 10.1016/j.ssmqr.2023.100373 -
Case Reports in Dentistry 2024Oral manifestations of mucocutaneous inflammatory diseases such as lichenoid dermatoses often affect the patient's quality of life through the symptoms of pain and...
Oral manifestations of mucocutaneous inflammatory diseases such as lichenoid dermatoses often affect the patient's quality of life through the symptoms of pain and burning sensation. In this case report, a patient with known lichen planus pigmentosus (LPP), a variant of lichenoid dermatoses that rarely affect oral mucosa, presented with chronic pain in the oral cavity for 2 months. Her intraoral examination revealed multiple pseudomembranous ulcers with erythematous areas and white striae similar to erosive lichen planus. The histological assessment revealed chronic mucositis, while the direct immunofluorescent examination showed negative results, contradicting the diagnosis of both lichen planus and LPP. Thus, the diagnosis was given as chronic mucositis, and the topical steroid was given. After 6 weeks of steroid application, the lesion resolved. To the best of our knowledge, this is the first report of chronic mucositis in LPP patients. This report could raise the awareness of clinicians to carefully take history as the patient with LPP may suffer from chronic mucositis in the oral cavity as well.
PubMed: 38911258
DOI: 10.1155/2024/1975932 -
Frontiers in Pediatrics 2024In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and...
In 2019, 80% of the 7.4 million global child deaths occurred in low- and middle-income countries (LMICs). Global and regional estimates of cause of hospital death and admission in LMIC children are needed to guide global and local priority setting and resource allocation but are currently lacking. The study objective was to estimate global and regional prevalence for common causes of pediatric hospital mortality and admission in LMICs. We performed a systematic review and meta-analysis to identify LMIC observational studies published January 1, 2005-February 26, 2021. Eligible studies included: a general pediatric admission population, a cause of admission or death, and total admissions. We excluded studies with data before 2,000 or without a full text. Two authors independently screened and extracted data. We performed methodological assessment using domains adapted from the Quality in Prognosis Studies tool. Data were pooled using random-effects models where possible. We reported prevalence as a proportion of cause of death or admission per 1,000 admissions with 95% confidence intervals (95% CI). Our search identified 29,637 texts. After duplicate removal and screening, we analyzed 253 studies representing 21.8 million pediatric hospitalizations in 59 LMICs. All-cause pediatric hospital mortality was 4.1% [95% CI 3.4%-4.7%]. The most common causes of mortality (deaths/1,000 admissions) were infectious [12 (95% CI 9-14)]; respiratory [9 (95% CI 5-13)]; and gastrointestinal [9 (95% CI 6-11)]. Common causes of admission (cases/1,000 admissions) were respiratory [255 (95% CI 231-280)]; infectious [214 (95% CI 193-234)]; and gastrointestinal [166 (95% CI 143-190)]. We observed regional variation in estimates. Pediatric hospital mortality remains high in LMICs. Global child health efforts must include measures to reduce hospital mortality including basic emergency and critical care services tailored to the local disease burden. Resources are urgently needed to promote equity in child health research, support researchers, and collect high-quality data in LMICs to further guide priority setting and resource allocation.
PubMed: 38910960
DOI: 10.3389/fped.2024.1397232 -
Risk Management and Healthcare Policy 2024Growing cyberattacks have made it more challenging to maintain healthcare information system (HIS) security in medical institutes, especially for hospitals that provide...
BACKGROUND
Growing cyberattacks have made it more challenging to maintain healthcare information system (HIS) security in medical institutes, especially for hospitals that provide patient portals to access patient information, such as electronic health record (EHR).
OBJECTIVE
This work aims to evaluate the patient portal security risk of Taiwan's EEC (EMR Exchange Center) member hospitals and analyze the association between patient portal security, hospital location, contract category and hospital type.
METHODS
We first collected the basic information of EEC member hospitals, including hospital location, contract category and hospital type. Then, the patient portal security of individual hospitals was evaluated by a well-known vulnerability scanner, UPGUARD, to assess website if vulnerable to high-level attacks such as denial of service attacks or ransomware attacks. Based on their UPSCAN scores, hospitals were classified into four security ratings: absolute low risk, low to medium risk, medium to high risk and high risk. Finally, the associations between security rating, contract category and hospital type were analyzed using chi-square tests.
RESULTS
We surveyed a total of 373 EEC member hospitals. Among them, 20 hospital patient portals were rated as "absolute low risk", 104 hospital patient portals as "low to medium risk", 99 hospital patient portals as "medium to high risk" and 150 hospital patient portals as "high risk". Further investigation revealed that the patient portal security of EEC member hospitals was significantly associated with the contract category and hospital type (<0.001).
CONCLUSION
The analysis results showed that large-scale hospitals generally had higher security levels, implying that the security of low-tier and small-scale hospitals may warrant reinforcement or strengthening. We suggest that hospitals should pay attention to the security risk assessment of their patient portals to preserve patient information privacy.
PubMed: 38910900
DOI: 10.2147/RMHP.S463408 -
F1000Research 2024This study investigates various surface treatment methods to assess shear bond strength between set Cention N (alkasite-based restorative material) and new alkasite...
BACKGROUND
This study investigates various surface treatment methods to assess shear bond strength between set Cention N (alkasite-based restorative material) and new alkasite based restorative material. Assessing different surface treatments provide insights in optimizing repair procedure that enables durability of the restoration, thus potentially benefitting clinical outcomes.
METHODS
A total of 48 alkasite based restorative material blocks, measuring 4 mm in depth and 4 mm in diameter, were prepared. The samples were randomly divided into 8 groups (n = 6) according to the surface treatment done. Group I: Surface preparation by bur; Group II: Surface treatment by laser; Group III: Application of 2-step etch and rinse adhesive (Adper Single Bond 2 adhesive),Group IV: Application of single step self-etch adhesive (Scotchbond Universal adhesive); Group V: Bur preparation followed by application of 2-step etch and rinse adhesive; Group VI: Bur preparation followed by application of single step self-etch adhesive; Group VII: Laser preparation followed by application of 2-step etch and rinse adhesive; and Group VIII: Laser preparation followed by application of single step self-etch adhesive. Post-surface preparation, all the specimens were restored with newly mixed alkasite material. Repair bond strength measurements were assessed with universal testing machine. Shapiro-Wilk and Levene's tests were used to check normality and Homogeneity of variance. ANOVA with post-hoc Games-Howell test and two-way ANOVA with post-hoc Bonferroni test was performed to evaluate the influence of surface preparation on the repair bond strength.
RESULTS
Using a 2-step etch and rinse adhesive resulted in a higher repair bond strength (26.05±2.12) compared to other surface treatments. In contrast, roughening of the surface with burs led to lowest repair bond strength (17.06±3.29) (P=0.02).
CONCLUSION
Application of 2-step etch and rinse adhesive to the existing alkasite based restorative material provides superior bonding with the newly added alkasite based restorative material.
Topics: Surface Properties; Dental Bonding; Shear Strength; Dental Materials; Materials Testing; Humans; Dental Restoration, Permanent
PubMed: 38910590
DOI: 10.12688/f1000research.148326.2