Criteria for the prescription of oral bisphosphonates for the treatment of osteoporosis in a series of women referred for tooth extraction

Objective: To evaluate the criteria for the prescription of oral bisphosphonates (OB) in a series of women with osteoporosis referred for tooth extraction. Study design: The study included 38 postmenopausal women on treatment with OBs. The following variables were analysed: age, weight, height, type of OB and duration of treatment, bone densitometry and risk factors for osteoporosis. In addition, the osteoporosis self-assessment tool (OST) was administered and collagen type I C- telopeptide (CTX) levels were measured. Results: Bone densitometry had only been performed in six patients (15.7%) before starting OB treatment. Based on the results of the OST, nine (23.6%) of the participants presented a low risk of osteoporosis. CTX levels were measured in 23 patients: 11 (47.8%) presented values below 150 pg/ml. Conclusion: Although all patients in the present series were on treatment with OBs, a large percentage did not satisfy the criteria for the initiation of treatment for postmenopausal osteoporosis

Prevalence of systemic diseases among patients requesting dental consultation in the public and private systems

Objectives: To determine the prevalence and aetiology of systemic disease among patients requesting dental treatment in public and private practice. Study Design: A retrospective analysis was performed of the medical histories of 2000 patients requesting dental treatment during the year 2009. One thousand patients came from the Fontiñas Primary Care Oral and Dental Health Unit of the Galician Health Service (SERGAS), Spain, and the other thousand from a private clinic; both clinics were situated in Santiago de Compostela, La Coruña, Spain. The data collected were the following: demographic data (age and sex), presence or absence of systemic diseases and the nosologic categories, and drug history (type and number of drugs). Results: The prevalence of systemic disease was significantly higher among patients seen in the public system (35.2% in the public system versus 28.1% in the private system; p= 0.003). The differences between the two systems were more marked when considering patients aged under 65 years, particularly with respect to rheumatic and endocrine-metabolic (diabetes) disorders. The prevalence of patients receiving polypharmacy (>4 drugs/day) was significantly higher among patients seen in the public system (5.7% in the public system versus 2.7% in the private system; p= 0.009). Conclusions: There is a high prevalence of medical disorders and of patients receiving polypharmacy among individuals requesting dental care, particularly in the public health system. Dentists must have adequate training in medical disease and must be fully integrated into primary care health teams in order to prevent or adequately resolve complications. © Medicina Oral S. L

Valor predictivo de la candidiasis oral como marcador de evolución a SIDA

Objetivo: Determinar la validez de la candidiasis oral (CO) como marcador clinico de evolucion en los pacientes infectados por el Virus de la Inmunodeficiencia Humana. Diseno del estudio: En 1992, se efectuo una exploracion oral a un colectivo de 200 pacientes infectados por VIH, con una edad media de 36,8'}7 anos (rango 25-46 anos) para establecer el diagnostico de CO. Se registraron las variables edad, sexo, tiempo de evolucion de la enfermedad, conducta de riesgo, numero de linfocitos CD4/'ÊL, estadio clinico y tratamiento antirretroviral. De los 200 pacientes del grupo de estudio, 157 no cumplian criterios de SIDA en el momento de la exploracion basal y a estos se les efectuo un seguimiento semestral hasta que cumplieron dichos criterios, concluyendo el estudio al final de 2001. Resultados: De los 157 pacientes seleccionados, 71 (45,2%) no presentaron CO y de estos el 28,7% evoluciono a SIDA durante el periodo de seguimiento. De los 86 (54,8%) pacientes con CO, el 48,2% evoluciono a SIDA (RR=2,71). Al trasladar el origen del estudio al ano 1997 cuando se inicio la administracion de la terapia antirretroviral de alta eficacia (TAAE), no se observaron diferencias en el porcentaje de pacientes que evolucionaron a SIDA en relacion a la existencia o no de CO en la exploracion basal. El analisis multivariante demostro que la asociacion de la variable de exposicion CO con la evolucion a SIDA no alcanzo un valor predictivo. Conclusiones: El valor pronostico a largo plazo de la CO, no se ha determinado en pacientes que reciben terapia antirretroviral de alta eficacia (TAAE). La recuperacion inmunologica y la disminucion de enfermedades oportunistas observadas tras la administracion de TAAE, hacen que muchos pacientes que alcanzaron la condicion de SIDA no cumplan en la actualidad dichos criterios, lo que obliga a renovar la propia definición del síndrome para poder evaluar marcadores de pronóstico.Objective: To determine the validity of oral candidiasis (OC) as a clinical marker of progression in patients with human immunodeficiency virus infection. Study design: In 1992, an oral examination was carried out on a group of 200 HIV-infected patients with a mean age of 36.8 ± 7 years (range 25-46 years) to establish the diagnosis of OC. The following variables were recorded: age, sex, duration of the disease, risk behaviour, CD4 lymphocyte count, clinical stage and antiretroviral treatment. Of the 200 patients in the group evaluated, 157 did not fulfil the criteria for AIDS at the time of the baseline examination; these patients constitute the study group and underwent 6-monthly follow-up until they fulfilled these criteria. The study was concluded at the end of 2001. Results: Of the 157 patients selected, 71 (45.2%) did not present OC and, of these, 28.7% progressed to AIDS during the followup period. Of the 86 (54.8%) patients with OC, 48.2% progressed to AIDS (RR= 2.71). If the start date of the study was taken as 1997, when highly active antiretroviral therapy (HAART) was introduced, no differences were found in the percentage of patients who progressed to AIDS with respect to the presence or absence of OC at the baseline examination. Multivariate analysis demonstrated that the association of the presence of OC with progression to AIDS did not reach a predictive value. Conclusions: The long-term prognostic value of OC has not been established in patients receiving highly active antiretroviral therapy (HAART). The immunological recovery and the reduction in the number of opportunistic diseases observed after the administration of HAART means that many patients who developed AIDS do not currently satisfy these criteria, making a review of the definition of the syndrome itself a necessity in order to be able to evaluate prognostic markers

Control of drooling using transdermal scopolamine skin patches : a case report

Transdermal scopolamine has been shown to be very useful in the management of drooling, particularly in patients with neurological or neuropsychiatric disturbances or severe developmental disorders. In this paper, we present the case of a 24-year-old patient with a diagnosis of cerebral palsy and a severe problem of drooling, exacerbated by marked mandibular prognathism. After exclusion of other therapeutic alternatives, it was decided to use sustainedrelease transdermal scopolamine patches (Scopoderm TTS). This technique consists of the application every three days of a patch with 1.5 mg of scopolamine in the area of the mastoid apophysis; the patch releases a dose of 0.5 mg of the active substance over each 24 hour period. The patient underwent periodic clinical and laboratory follow-up over a period of three years, achieving satisfactory results with no significant undesirable effects

Oral amoxicillin/clavulanate for the prevention of bacteremia following dental extractions

This study aimed to evaluate the effectiveness of oral amoxicillin/clavulanate (AMX-CL) for the prevention of bacteremia following dental extractions. The study group (AMX-CLG) comprised 40 adults requiring dental extractions under general anesthesia who were administered a prophylactic regimen of 1875/125 mg of AMX-CL orally 1–2 h prior to the surgery. Venous blood samples were collected from each patient at baseline and at 30 s and 15 min after dental extractions. Samples were inoculated into BACTEC Plus culture bottles and processed in the BACTEC 9240. Conventional microbiological techniques were used for subcultures and further identification of the isolated bacteria. The results for the AMX-CLG were compared with those of a control group (CG; no prophylaxis) and an amoxicillin group (AMXG; 2 g of amoxicillin orally), consisting of randomly selected patients from among those participating in two clinical trials that we have previously published. The prevalence of bacteremia in the CG, AMXG, and AMX-CLG was 97%, 50%, and 15%, respectively, at 30 s after completing the extractions, and 67%, 10%, and 4% at 15 min, respectively, after the last extraction. The prevalence of bacteremia in the AMXG and the AMX-CLG at 30 s and at 15 min after completing the extractions was significantly lower than that in the CG (p < 0.001 and p < 0.001, respectively; Fisher’s exact test). The prevalence of bacteremia in the AMX-CLG at 30 s after completing the extractions was significantly lower than that in the AMXG (p < 0.001; Fisher’s exact test). Based in the results of this preliminary study, oral AMX-CL could be an excellent option for preventing bacteremia secondary to dental procedures in patients at riskS

Oral bisphosphonate-related osteonecrosis of the jaws : clinical characteristics of a series of 20 cases in Spain

Objective: The objective of this study was to define the clinical characteristics of osteonecrosis of the jaws (ONJ) induced by oral bisphosphonates in a series of patients from a circumscribed area in northwest Spain. Study Design: A retrospective multicentre study was undertaken in 3 hospitals in an area with a radius less than 100 km in the Autonomous Community of Galicia (Spain). The medical records were reviewed and an oral examination was performed of patients diagnosed with oral bisphosphonate-related ONJ in the previous 3 years. Results: We detected 20 cases of ONJ (24 lesions) related to oral bisphosphonates (alendronate [16 patients] and ibandronate [4 patients]), which were mainly administered as treatment for osteoporosis (17 patients). The mean interval between initiation of treatment and confirmation of a diagnosis of ONJ was 66±43 months (range, 6-132 months); in 7 patients (35%) the interval was less than 36 months. The past history revealed hypertension in 13 cases (65%) and diabetes in 4 (20%); 7 patients (35%) were on corticosteroid treatment. Oral surgery had been previously performed in 13 patients (65%) and the remaining 7 patients (35%) had removable dental prostheses. The lesions most frequently affected the posterior mandible (62.5%). The majority of the lesions (75%) were classified as stage 2, although lesions were identified in all established clinical stages (including 2 stage 0 lesions). Conclusion: In conclusion, in the present series, ONJ induced by oral bisphosphonates typically develops in women around 70 years of age, taking alendronate, that underwent oral surgery. Most lesions are located in the posterior mandible and are classified as stage 2 at diagnosis. Some patients presented no known risk factors, suggesting that there may be risk factors still to be identified. There are well-defined patterns of clinical presentation that can facilitate early diagnosis of ONJ

Morphometry of the trabecular meshwork in vivo in a healthy population using fourier-domain optical coherence tomography

PURPOSE. We measured the length, thickness, and area of the trabecular meshwork (TM) in vivo using Fourier domain optical coherence tomography (FD-OCT) in a Caucasian population of healthy subjects. METHODS. A cross-sectional study was done of 1006 healthy subjects. Left eyes were randomly selected. Age, sex, IOP, and spherical refractive error were noted. The depth and volume of the anterior chamber and the central corneal thickness were measured with Pentacam, while IOL Master was used to measure the axial length. The length, thickness, and area of the TM were measured through FD-OCT RTVue. A study was done to determine the correlation between TM size, and other demographic and ocular parameters. Finally, the reproducibility of the measurements was assessed for a subgroup of 50 eyes from 50 patients. RESULTS. We were able to measure the TM in 91.1% of the total eyes studied. The mean TM length was 496.99 6 92.77 lm (range, 275–800), TM thickness was 174.16 6 28.14 lm (range, 100–276), and TM area was 0.069 6 0.031 mm2 (range, 0.023–0.133). No differences were found in terms of length and area for sex, although the TM was slightly thicker in men (P ¼ 0.046). No correlation was observed between the TM measurements and any of the studied demographic or ocular parameters (R 0.750, P < 0.001). CONCLUSIONS. The FD-OCT is an effective and reproducible examination technique to measure the length, thickness, and area of the TM in vivo

Screening for hypertension in a primary care dental clinic

Objective: The aim of this study was to record blood pressure in patients during their visit to a dental clinic, with the aim of identifying those who have high blood pressure and are unaware of it, as well as those who are aware of their condition but do have their blood pressure under adequate control. Study design: We designed a cross-sectional study which included 154 patients who were seen for a dental checkup at the Primary Dental Care of the Gallician Health Service (SERGAS). All participants completed a standardized medical questionnaire after measuring their systolic blood pressure (SBP) and diastolic blood pressure (DBP), which was conducted using the protocol established by the Spanish Society of Hypertension-Spanish League for the Fight Against Hypertension (HTA). Results: In 45 patients (29%), the figures for blood pressure were recorded as SBP?140 mmHg and/or DBP ?90 mmHg, indicating that they may have hypertension. Only 12 of them had been previously diagnosed with hypertension, but did not have their blood pressure under adequate control. The remaining 33 had no history of hypertension and were referred to a family physician, but only 19 saw their doctor; 11 of these patients were given non-pharmacological treatment, 6 were prescribed drug treatment and no type of treatment was indicated for the other two patients. Conclusions: By screening for hypertension, especially among patients who are more than 40 years old, the dentist can play an important role in the early diagnosis

In Vivo Antiplaque Effect of Three Edible Toothpastes

Objectives: The objective of this study was to analyse the antibacterial and antiplaque activity of three edible toothpastes with the widest worldwide distribution: KidScents™, which contains essential oils; Browning B&B™,, with medicinal plants; and Wysong Probiodent™, which contains probiotics. Study Design: The study group was formed of twenty healthy volunteers (dental students) with a good oral health status. Using a balanced randomisation system, all volunteers performed toothbrushing with four products (the three edible toothpastes and water) at intervals of one week. Bacterial vitality in the saliva was analysed by epifluorescence microscopy and plaque regrowth was evaluated using the Turesky-Quigley-Hein plaque index. Results: Bacterial vitality in the saliva was significantly higher after toothbrushing with water (positive control) than with the three toothpastes (P=0.002, P=0.003 and P<0.001, respectively). The plaque index was significantly higher after using these three toothpastes than after toothbrushing with water (P=0.047, P=0.032 and P<0.001, respectively). Conclusions: The three edible toothpastes analysed have some antimicrobial activity but favour plaque regrowth

Cybersecurity Alert Prioritization in a Critical High Power Grid With Latent Spaces

High-Power electric grid networks require extreme security in their associated telecommunication network to ensure protection and control throughout power transmission. Accordingly, supervisory control and data acquisition systems form a vital part of any critical infrastructure, and the safety of the associated telecommunication network from intrusion is crucial. Whereas events related to operation and maintenance are often available and carefully documented, only some tools have been proposed to discriminate the information dealing with the heterogeneous data from intrusion detection systems and to support the network engineers. In this work, we present the use of deep learning techniques, such as Autoencoders or conventional Multiple Correspondence Analysis, to analyze and prune the events on power communication networks in terms of categorical data types often used in anomaly and intrusion detection (such as addresses or anomaly description). This analysis allows us to quantify and statistically describe highseverity events. Overall, portions of alerts around 5-10% have been prioritized in the analysis as first to handle by managers. Moreover, probability clouds of alerts have been shown to configure explicit manifolds in latent spaces. These results offer a homogeneous framework for implementing anomaly detection prioritization in power communication networks