Principles of Periodontology

Periodontal diseases are among the most common diseases affecting humans. Dental biofilm is a contributor to the etiology of most periodontal diseases. It is also widely accepted that immunological and inflammatory responses to biofilm components are manifested by signs and symptoms of periodontal disease. The outcome of such interaction is modulated by risk factors (modifiers), either inherent (genetic) or acquired (environmental), significantly affecting the initiation and progression of different periodontal disease phenotypes. While definitive genetic determinants responsible for either susceptibility or resistance to periodontal disease have yet to be identified, many factors affecting the pathogenesis have been described, including smoking, diabetes, obesity, medications, and nutrition. Currently, periodontal diseases are classified based upon clinical disease traits using radiographs and clinical examination. Advances in genomics, molecular biology, and personalized medicine may result in new guidelines for unambiguous disease definition and diagnosis in the future. Recent studies have implied relationships between periodontal diseases and systemic conditions. Answering critical questions regarding host‐parasite interactions in periodontal diseases may provide new insight in the pathogenesis of other biomedical disorders. Therapeutic efforts have focused on the microbial nature of the infection, as active treatment centers on biofilm disruption by non‐surgical mechanical debridement with antimicrobial and sometimes anti‐inflammatory adjuncts. The surgical treatment aims at gaining access to periodontal lesions and correcting unfavorable gingival/osseous contours to achieve a periodontal architecture that will provide for more effective oral hygiene and periodontal maintenance. In addition, advances in tissue engineering have provided innovative means to regenerate/repair periodontal defects, based upon principles of guided tissue regeneration and utilization of growth factors/biologic mediators. To maintain periodontal stability, these treatments need to be supplemented with long‐term maintenance (supportive periodontal therapy) programs

What motivates patients with NCDs to follow up their treatment?

Workshop at the 31st Medical Informatics Europe virtual conference, 29.05.21 - 31.05.21: https://efmi.org/2020/12/10/31st-medical-informatics-europe-conference-mie2021-athens-greece/.The increasing use of mobile health (mHealth) tools for self-management is considered to be important to improve health effects for patients with chronic NCDs (noncommunicable diseases). This development is supported by an increasing number of available mHealth apps. The apps range from disease management apps (e.g., diabetes diary) to health and fitness apps (e.g., dietary apps and workout apps). However, there seems to be a lack of motivation from most users to keep using these health apps over a long period of time [1]. This may be because of the way these apps were designed and developed, i.e. lack of co-participatory design techniques and lack of a tested developer guideline for creating mHealth solutions. The motivation behind this workshop is to identify motivational factors which will increase adoption and usage of mHealth apps. Since 2001, several of the presenters have been working on self-management tools for people with diabetes [2, 3]. The main tool is a diabetes diary – the “Few Touch Application” (Norwegian, “Diabetesdagboka”), available for free from Google Play, and used by several thousands of users [4-8]

EDMON - Electronic Disease Surveillance and Monitoring Network: A Personalized Health Model-based Digital Infectious Disease Detection Mechanism using Self-Recorded Data from People with Type 1 Diabetes

Through time, we as a society have been tested with infectious disease outbreaks of different magnitude, which often pose major public health challenges. To mitigate the challenges, research endeavors have been focused on early detection mechanisms through identifying potential data sources, mode of data collection and transmission, case and outbreak detection methods. Driven by the ubiquitous nature of smartphones and wearables, the current endeavor is targeted towards individualizing the surveillance effort through a personalized health model, where the case detection is realized by exploiting self-collected physiological data from wearables and smartphones. This dissertation aims to demonstrate the concept of a personalized health model as a case detector for outbreak detection by utilizing self-recorded data from people with type 1 diabetes. The results have shown that infection onset triggers substantial deviations, i.e. prolonged hyperglycemia regardless of higher insulin injections and fewer carbohydrate consumptions. Per the findings, key parameters such as blood glucose level, insulin, carbohydrate, and insulin-to-carbohydrate ratio are found to carry high discriminative power. A personalized health model devised based on a one-class classifier and unsupervised method using selected parameters achieved promising detection performance. Experimental results show the superior performance of the one-class classifier and, models such as one-class support vector machine, k-nearest neighbor and, k-means achieved better performance. Further, the result also revealed the effect of input parameters, data granularity, and sample sizes on model performances. The presented results have practical significance for understanding the effect of infection episodes amongst people with type 1 diabetes, and the potential of a personalized health model in outbreak detection settings. The added benefit of the personalized health model concept introduced in this dissertation lies in its usefulness beyond the surveillance purpose, i.e. to devise decision support tools and learning platforms for the patient to manage infection-induced crises

Development of Assessment and Screening Tool to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics

Abstract Development of Assessment and Screening Tool to Assist with Prevention and Identification of Charcot Foot in Type 2 Diabetics by Louise Wade MSN, RN MS, West Texas A&M University, 2010 BS, West Texas A&M University, 2010 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2016 Abstract According to the World Health Organization, up to 50% of type 2 diabetic patients develop neuropathy, which may cause major infections, amputation, and Charcot foot due to impaired sensation. Early recognition and care is essential for treatment of Charcot foot and prevention of further injury. Due to the complexity of this potentially life threatening complication, assessment is challenging, especially when practitioners who treat adult diabetic patients may not be familiar with Charcot foot. The purpose of this scholarly project was to develop an assessment, screening tool, and algorithm for detecting Charcot foot; an additional goal was to develop practice guidelines for practitioners to assist in the early recognition, treatment, and referral of adult diabetic patients at risk for Charcot foot. Lippitt\u27s theory of change was used to guide the project. An interdisciplinary team of stakeholders was assembled to guide development of the tool, algorithm, and practice guidelines. Products were developed in accordance with evidence in current peer-reviewed literature and American Diabetes Association recommendations for Charcot foot diagnosis, treatment, and referral. Content was validated using a scale content validation instrument process to obtain input from experts in the care of Charcot foot. An implementation plan was developed to guide introduction of the products into practice, and an evaluation plan created to determine the extent to which intermediate term outcomes are met using these products. The project may contribute to social change by identifying patients at risk for Charcot foot prior to the onset of the complication, therefore preventing further injury, deformity, or amputation in populations that are often unable to afford quality healthcare

Genetics of Type 2 Diabetes - Pitfalls and Possibilities

Type 2 diabetes (T2D) is a complex disease that is caused by a complex interplay between genetic, epigenetic and environmental factors. While the major environmental factors, diet and activity level, are well known, identification of the genetic factors has been a challenge. However, recent years have seen an explosion of genetic variants in risk and protection of T2D due to the technical development that has allowed genome-wide association studies and next-generation sequencing. Today, more than 120 variants have been convincingly replicated for association with T2D and many more with diabetes-related traits. Still, these variants only explain a small proportion of the total heritability of T2D. In this review, we address the possibilities to elucidate the genetic landscape of T2D as well as discuss pitfalls with current strategies to identify the elusive unknown heritability including the possibility that our definition of diabetes and its subgroups is imprecise and thereby makes the identification of genetic causes difficult.Peer reviewe

Circulating angiogenic stem cells in diabetes.

Circulating angiogenic stem cells (CACs) are rare cells found in peripheral blood that have been shown to contribute to endothelial repair and new blood vessel formation. These cells could be biomarkers and/or therapeutic targets for the assessment and prevention of cardiovascular disease (CVD), which is the leading cause of mortality globally and in the United States. Diabetes is an independent risk factor for CVD, and there are inconsistent reports on the role of CACs in diabetic vasculopathy. To study this further we tested the hypothesis that diabetes depletes circulating levels of CACs, due to hyperglycemia or insulin resistance and that CAC depletion contributes to vascular dysfunction associated with diabetes. It was further proposed that in subjects with diabetes CACs may be dysfunctional. Studies presented here identify one subgroup of CAC, (CAC-3: AC133+/CD34+/CD45dim/CD31+/CD14-), that is reduced in diabetes and whose levels are negatively associated with hyperglycemia and endothelial function. Furthermore we found that increased plasma levels of soluble ICAM-1 are also associated with decreased CAC-3 levels and VEGFR2 surface expression. Our results also show that subjects with diabetes have CACs with decreased adhesive and proliferative capacity. These studies identify the specific CAC phenotypes that are affected by diabetes and suggest that CAC levels are a robust index of long-term glycemic control and that their levels reflect hyperglycemia rather than insulin levels. These studies also suggest that CAC levels may be monitored by bedside assessment of endothelial function

Global Perspective on Diabetic Foot Ulcerations

Over the last decade, it is becoming increasingly clear that diabetes mellitus is a global epidemic. The influence of diabetes is most readily apparent in its manifestation in foot complications across cultures and continents. In this unique collaboration of global specialists, we examine the explosion of foot disease in locations that must quickly grapple with both mobilizing medical expertise and shaping public policy to best prevent and treat these serious complications. In other areas of the world where diabetic foot complications have unfortunately been all too common, diagnostic testing and advanced treatments have been developed in response. The bulk of this book is devoted to examining the newest developments in basic and clinical research on the diabetic foot. It is hoped that as our understanding of the pathophysiologic process expands, the devastating impact of diabetic foot complications can be minimized on a global scale

Clinical Phenotypes of COVID-19 Associated Mucormycosis (CAM): A Comprehensive Review

SARS-CoV-2; Diabetes mellitus; Invasive fungal infectionsSARS-CoV-2; Diabetes mellitus; Infecciones fúngicas invasivasSARS-CoV-2; Diabetis mellitus; Infeccions fúngiques invasivesA mucormycosis surge was reported during the COVID-19 pandemic in India. A literature search until 14 July 2022, with the aim of updating COVID-19-associated mucormycosis (CAM), identified 663 studies and 88 met inclusion criteria (8727 patients). India reported 8388 patients, Egypt 208 and Europe 40. Rhino-orbito-cerebral mucormycosis (ROCM) was identified among 8082 (98.3%) patients, followed by 98 (1.2%) with pulmonary. In India, 82.6% of patients had diabetes mellitus, with 82% receiving corticosteroids. In Europe, 75% presented pulmonary CAM, 32.5% had diabetes and 40% were immunocompromised. CAM was identified at a median of 17.4 days (IQR 7.5 days) post COVID-19 diagnosis, and PCR was performed in five studies. Rhino-orbital invasion is clinically obvious, while cerebral involvement presents with cavernous sinus thrombosis, meningitis and cerebrovascular disease. Symptoms of pulmonary CAM usually overlap with severe COVID-19 pneumonia. High-dose liposomal Amphotericin B (and early surgical debridement in ROCM) are the mainstay of therapy. The median mortality rate was estimated to be 21.4% (IQR 31.9%), increased by the presence of pulmonary (80% (IQR 50%) or cerebral involvement (50% (IQR 63.9%). In summary, different CAM clinical phenotypes need to be distinguished, influenced by geographical presentation. Opportunities exist for diagnosis and therapy optimization, based on earlier high-dose antifungal therapy, early source control, strict glycemic control and restriction of steroids to COVID-19 patients with oxygen requirements