The Use of a Disclosing Agent During Resective Periodontal Surgery for Improved Removal of Biofilm

A total removal of the bacterial deposits is one of the main challenges of periodontal therapy. A surgical approach is sometimes required in order to allow a correct access to the areas not thoroughly reached during the initial therapy. The present study focuses on the surgical scaling effectiveness in root deposits removal; the potential support of a disclosing agent during this procedure is also evaluated. Forty surgical periodontal patients were randomly divided between surgeries where the operator was informed about a final examination of the residual root deposits and surgeries where the operator was not informed. Straight after scaling procedures a supervisor recorded the O’Leary Plaque Index of the exposed roots by mean of a disclosing agent and the percentage of teeth with residual biofilm. After the stained deposits removal, a second chromatic examination was performed and new data were collected. Mann-Whitney U-test and Wilcoxon test for paired samples were used for comparisons respectively between the two surgery groups and the first and the second chromatic examination; one-sided p-value was set at 0.05. At first examination no significant differences between the two groups were observed regarding Plaque Index (p=0.24) and percentages of teeth with residual biofilm (p=0.07). The 100% removal of roots deposits was never achieved during the study but a significant reduction of 80% of root deposits was observed between first and second examination (p=0.0001). Since root deposits removal during periodontal surgery resulted always suboptimal, the use of a disclosing agent during this procedure could be a useful and practical aid

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Metas de colesterol LDL en pacientes sometidos a revascularización periférica

Background: Patients with peripheral vascular disease represent a group at high risk of cardiovascular events, and must therefore achieve the secondary prevention goals recommended in the guidelines. Objectives: Primary: To determine what percentage of patients undergoing peripheral revascularization surgery reached LDL cholesterol goals at 6 months of the  intervention compared with patients undergoing coronary artery bypass grafting. Secondary: To determine the percentage of patients reaching these levels at 18 months of follow-up, the percentage of patients with total cholesterol dosage and lipid fraction (LDL-C, HDL-C and TG) assessment at 6 and 18 months of follow-up and the percentage of statin use during the previous year and during the long term follow-up after surgery. Methods: The degree of lipid control in a retrospective cohort of patients undergoing peripheral revascularization surgery was compared with another group of patients undergoing coronary artery bypass grafting at 6 months and 18 months of the procedure. Results: A total of 468 individuals, 98 undergoing surgery for peripheral vascular disease and 370 for coronary artery disease were followed up for a period of 18 months. Mean LDL-C at 6 months of surgery was significantly higher in the vascular than in the coronary patients (98.8±35 mg/dl vs. 84.7±25 mg/dl, p=0.001), but lost significance at 18 months (93.3±23 mg/dl vs. 88±26 mg/ dl, p=0.25). The percentage of patients achieving LDL-C targets <100 mg/dl was 27.5% vs. 48.6% (p <0.0001) at 6 months in the vascular and coronary patients, respectively, and 22.5% vs. 37.3% (p=0.006) at 18 months. Conclusion: A lower percentage of patients undergoing surgical procedures for peripheral revascularization achieve LDL-C targets compared with those undergoing coronary revascularization.Introducción. Los pacientes con enfermedad vascular periférica representan un grupo de alto riesgo de eventos cardiovasculares por lo que deben alcanzar metas de prevención secundaria de enfermedad cardiovascular. Objetivos. Determinar qué porcentaje de pacientes sin antecedentes de enfermedad coronaria sometidos a cirugía vascular (CV) alcanzan las metas de colesterol luego de ser intervenidos en relación a  pacientes sometidos a cirugía de revascularización miocárdica (CRM) electiva. Materiales y Métodos Se comparó el grado de control de dislipemia de una cohorte retrospectiva de  pacientes sometidos a CV sin antecedentes clínicos de enfermedad coronaria en relación a pacientes sometidos a cirugía de revascularización coronaria. Resultados. Se siguieron 468 individuos, 98 operados de CV y 370 de CRM por un periodo de 18 meses. La media de LDL a los 6 meses de la cirugía fue significativamente menor en los coronarios que en los vasculares (84.7±25  vs. 98.8±35 mg/dl; p=0.001). Esta diferencia se mantuvo a los 12 meses post operatorio (91,6±28.5 vs. 102 ±39; p=0.04) pero se pierde a los 18 meses  (88±26 vs 93.3±23 mg/dl; p=0.25) La tasa de alcance de metas de LDL <100mg/dl a 6 meses en vasculares y coronarios fue 27,5% vs 48.6%; p<0.0001; OR 2.4 (1.4-4.0), a 12 meses 26.5% vs 35.1%; p=0.10; OR 1.3(0.8-2.3) y a 18 meses 22.5% vs 37.3%; p=0.006; OR 1.7(1.01-2.9). Conclusiones. Los pacientes sometidos a procedimientos de revascularización periférica son controlados menos intensamente y alcanzan en menor medida las metas de C-LDL que los pacientes sometidos a CRM

Early reperfusion and late clinical outcomes in patients presenting with acute myocardial infarction randomly assigned to primary percutaneous coronary intervention or streptokinase

Primary percutaneous coronary intervention (PCI) has become an alternative to thrombolytic therapy as a reperfusion strategy for ST-elevation acute myocardial infarction (AMI). The main goal of this study was to determine whether PCI and thrombolytic therapy achieve comparable reperfusion rates, as evidenced by ST-segment resolution. Secondary end points included infarct vessel patency rates before hospital discharge and short- and long-term outcomes. Patients with ischemic chest pain with duration ≤12 hours and no contraindication for thrombolytic therapy were included. Between October 1993 and August 1995, 58 patients were randomly assigned to streptokinase (SK) and 54 patients to primary PCI. Baseline clinical characteristics and infarct location were well balanced in both groups. Median age (interquartile range) was 68 (58, 75) years, 29% were women, and 78% of the patients met at least one criterion for “not low risk” AMI (anterior location, age >70 years old, previous MI, systolic blood pressure 100 bpm). The median time from symptom onset to random assignment was 217 (139, 335) minutes in the PCI group and 210 (145, 334) minutes in the SK group. Median random assignment to balloon time was 82 (55, 100) minutes, and median random assignment to needle time was 15 (10, 26) minutes ( P < .0001). TIMI grade 3 flow after primary PCI was obtained in 85% of patients. The proportion of patients with ST-segment resolution ≥50% at 120 minutes was 80% in the PCI group and 50% in the SK group ( P = .001). The predischarge angiogram showed the presence of TIMI 3 flow in 96% of patients who received PCI and 65% of patients who received SK ( P < .001). A composite of in-hospital death, reinfarction, severe heart failure, stroke, and major bleeding occurred in 15% of patients who received PCI and 21% of patients who received SK ( P = .4). At 3 years, freedom from the composite end point of AMI, postdischarge revascularization, and death was 61% in the PCI group and 40% in the SK group ( P = .025). Our study shows that primary PCI, as compared with SK, is associated with more effective ST-segment resolution, higher patency rates in the infarct vessel at 7 days, and more favorable clinical outcomes at 3 years of follow-up