Health care in patients with inflammatory diseases of the cornea - Keratoconus

Кератоконусът е вродено, невъзпалително заболяване с неизяснена етиология. Характеризира се с изтъняване и конусовидно изкривяване на роговицата, в следствие на което се нарушава пречупвателната й способност и зрителната острота прогресивно намалява. Заболяването се проявява обикновено през пубертета до около 20-годишна възраст.В ранните етапи на заболяването зрението може да бъде коригирано с очила. В последствие средство за избор представляват твърдите контактни лещи, които остават за по-продължителен период. Последният стадий на заболяването изисква хирургична намеса и трансплантация на роговица от донор.В статията е представен съвременният метод за лечение Crosslinking, който използва рибофлавин и облъчване с ултравиолетова светлина, с цел създаване на нови колагенови връзки и уплътняване на роговицата, кератопластика, както и хирургичната алтернатива на кератопластика - имплантиране на интрастромални корнеални пръстени, което води до оплоскостяване на роговицата и укрепване на роговичния слой. Представен е алгоритъм за качество на здравните грижи в предоперативния и следопeративния период при пациент след кератопластика, както и програма за обучение на пациента в домашни условия.Алгоритъмът на поведение ще допринесе за качеството на здравните грижи и ще подпомогне пациентите да избегнат усложнения в домашни условия.Keratoconus is innate, non-inflammatory disease of unknown etiology. It is characterized by thinning and conical distortion of the cornea resulting in the loss of its refractive ability and progressive reduction of visual acuity. The disease usually occurs in adolescence up to about the age of 20.In the early stages of the disease, vision can be corrected with glasses. Subsequently, the selected means are hard contact lenses, which remain for a longer period. The last stage of the disease requires surgery and corneal transplant from a donor.The article presents the modern treatment method Crosslinking, that uses riboflavin and UV light to create new collagen connections and sealing corneal keratoplasty, as well as a surgical alternative to keratoplasty - implantation of intrastromal corneal rings, leading to flattening of the cornea and strengthening of the corneal layer. An algorithm is presented for the quality of health care in the preoperative and postoperative patient after keratoplasty and a training program for the patient at home. The algorithm of behavior will contribute to the quality of care and help patients avoid complications at home

Effectiveness of the impact of second-generation platelet-rich fibrin prf in the treatment of localized individual gingival recessions miller I and II (case report)

The muco-gingival surgical modality SCTG + CAF(subepithelial connective tissue graft-SCTG + coronary positioned flap-CAF) in the treatment of Miller I and II gingival recessions is considered the “gold standard” technique for predictive and complete root coverage of the gingival defects, with long-term clinical stability of the results obtained. The counterpart of this type of technique is the relatively young PRF + CAF operating mode, which recently has a large number of supporters, primarily due to the biological characteristics of this autologous platelet concentrate-PRF (angiogenesis, mitogenesis, osteopromotion, immunomodulation and stem cell entrapment). Aim: The aim of this paper is to evaluate the clinical efficiency of the CAF + PRF combined technique in the treatment of localized individual gingival recessions Miller I and II, by comparing the values of periodontal clinical parameters measured preoperatively and 1 month postoperatively, as well as by the obtained immunohistochemical analysis of the biopsy material taken from the recipient site (the area of the grafted gingival defect), 1 month postoperatively. Material and method: Case report: A 37-year- old man was admitted to the Clinic “St. Panteleimon-Skopje, at the Oral Surgery department for surgical treatment of localized maxillary gingival recession Miller II, tooth 31. Preoperative measurements of periodontal clinical parameters were performed: vertical dimension of gingival recession (RD / VGR), depth of periodontal pocket (PPD/PD) keratinized / attached gingival level (CAL), keratinized gingival width (KTW/ KMW) and gingival thickness (GT) all measured in mm, including gingival biotype. CAF + PRF therapeutic modality is used to treat gingival defect. One month postoperatively, re-measurements of the values of the clinical periodontal indices were performed and they were compared with the measurements obtained preoperatively. Results: Significant reduction of RD, PPD and CAL values were determined on the measurements 1 month postoperatively. Conclusion: Insignificant values of KTW and GT were noted one month post.opp. There are no changes in gingival biotype before and postoperatively. PRF as a second generation of autologous concentrate is not only an adjuvant and / or replacement of the SCTG- “gold standard” in the treatment of Miller I and II, but is also a superior alternative in the surgical treatment of this type of superficial mucogingival defects

Laser analgesic during orthodontic therapy

Introduction: Most of the patients feel pain 4 hours after the arch applying, gaining the highest level after 24 hours and its lowering in the next few days. Literature reports show that the fear of pain is a very important reason for discouraging the patient to agree for this kind of orthodontic treatment The aim of this study was to evaluate the effectiveness of the biostimulative laser treatment in pain reduction in patients with fixed orthodontic appliances. Materials and methods. Fifteen patients were treated with low energy level biostimulative diode laser, used 2 minutes per quadrant immediately after placement of fixed orthodontic appliances and in the following four days. The control group of 15 patients received analgesic therapy for period of five days. The pain was assessed subjectively as strong, medium or no pain. The pain disappeared in 20% of the subjects in the examined group after the first day, while in 60% and 26.6% of the subjects medium and isolated pain was still present at day 2 and 3, respectively. Results. The pain disappeared in all the patients treated with laser at day 5. In the control group, strong pain was present in all the subjects the first day, decreasing to 60% of strong pain and 20% medium pain the second day. After day three, the control group demonstrated medium localized pain in 40% of the cases, which dropped to 26.6% after the fourth day, suggesting delayed pain reduction, compared to the laser treated group. Conclusion. Our results suggest that the low energy laser treatment can successfully be used for pain reduction during the initial discomfort period after placing fixed orthodontic appliances

Genetic correlation between amyotrophic lateral sclerosis and schizophrenia

A. Palotie on työryhmän Schizophrenia Working Grp Psychiat jäsen.We have previously shown higher-than-expected rates of schizophrenia in relatives of patients with amyotrophic lateral sclerosis (ALS), suggesting an aetiological relationship between the diseases. Here, we investigate the genetic relationship between ALS and schizophrenia using genome-wide association study data from over 100,000 unique individuals. Using linkage disequilibrium score regression, we estimate the genetic correlation between ALS and schizophrenia to be 14.3% (7.05-21.6; P = 1 x 10(-4)) with schizophrenia polygenic risk scores explaining up to 0.12% of the variance in ALS (P = 8.4 x 10(-7)). A modest increase in comorbidity of ALS and schizophrenia is expected given these findings (odds ratio 1.08-1.26) but this would require very large studies to observe epidemiologically. We identify five potential novel ALS-associated loci using conditional false discovery rate analysis. It is likely that shared neurobiological mechanisms between these two disorders will engender novel hypotheses in future preclinical and clinical studies.Peer reviewe

When to extract a compromised tooth

There are often questions and doubts concerning the decision-making process in regard to the prognosis of an individual tooth. Unfortunately in dentistry, as in all biologic sciences, there are no straightforward answers to questions. Decisions concerning the survival of the tooth are often made by specialists without any uniform criteria, usually only on the base of their previous experience. This article will look at the literature in this area to help the practitioner in the decision-making process what to do with the compromised tooth. In order to help clinicians to make better choice, factors and variables that can influence the final decision are discussed as factors influencing initial assessment, periodontal disease severity, fur-cation involvement, ethological factors, restorative and other factors. Although there are many literature data concerning this subject, no simplified and precise criteria are offered; so further work should be done in attempt to make some more uniform criteria concerning this subject

Extemporaneous preparation - past, present and future physicians' attitudes and beliefs

In recent years, major advances in the spheres of computer, automation and robotics technologies have re-shaped the pharmacy practice and have enabled machines to perform various tasks – preparation of medicines, dose verification, choosing the appropriate route of drug administration, distribution and dispensing of medicines. As artificial intelligence (AI) robots have taken over many of pharmacists’ functions in a business environment with a constantly increasing number of nationally authorized drugs, the focus of phar-macy profession has shifted from the traditional drug preparation and dispensing to the provision of patient counseling on the appropriate drug use.The purpose of this study was to analyze physicians’ attitudes towards extemporaneous prescribing and dis-pensing. We performed a direct anonymous survey among general practitioners and medical specialists in the city of Varna, Bulgaria. Although a dwindling number of pharmacy practices are being registered for extemporaneous preparation in accordance with the current pharmacopoeia and magistral formulae, the necessity and the advantages of extemporaneous medicines are indisputable.Our study findings show that extemporaneous medications are preferred by physicians to meet the need of a tailored approach to patient care, individualized drug dosing, and selection of the suitable route of drug ad-ministration, particularly in young children.Despite the abundance of industrially manufactured pharmaceuticals, extemporaneous medications are still often prescribed and prepared when there are no appropriate market alternatives

Hydrofluoric Acid: Burns and Systemic Toxicity, Protective Measures, Immediate and Hospital Medical Treatment

BACKGROUND: Hydrofluoric acid is a commonly used chemical in many industrial branches, but it can also be found as an ingredient in household products such as cleaning agents. Possessing high corrosive potential, HF acid causes burns and tissue necrosis, while when absorbed and distributed through the bloodstream, its extremely high toxic potential is expressed. Acute symptoms are often followed by pain, particularly in the case of skin burns, which intensiveness does not often correlate with the expressiveness of the clinical findings. Even exposure to low-concentrated solutions or gasses, or low-doses of high-concentrated acid, may provoke delayed systemic disorder which may eventually have a lethal outcome. AIM: Therefore, having information regarding the possible hazardous effects of hydrofluoric acid usage, a variety of symptoms, as well as a treatment approach, is of great importance in the case of HF exposure. METHODS: Available scientific articles published in literature databases, scientific reports and governmental recommendations from the internet websites, written in English, using the following search terms “Hydrofluoric acid, skin burns, eye injury, ingestion, inhalation, systemic toxicity, decontamination, antidote, medical treatment” have been reviewed. RESULTS: This review is useful not only for physicians but for everyone who may come in contact with a person exposed to HF acid. CONCLUSION: It highlights the mechanism of action, presents the acute and chronic symptoms, personal and general protective measures and devices that should be used, as well as decontamination procedures, immediate, antidote and hospital medical treatment

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk