Ocena rzetelności zakresu ruchów żuchwy polskiej wersji kwestionariusza osobowego Badawczych Kryteriów Diagnostycznych Zaburzeń Czynnościowych Układu Ruchowego Narządu Żucia

Wstęp. Ważnym krokiem we wdrożeniu kryteriów diagnostycznych dla badań naukowych jest przeprowadzenie oceny wiarygodności zakresu ruchu żuchwy w przetłumaczonej i dostosowanej do polskich realiów wersji RDC/TMD. Materiał i metody. Łącznie 123 dorosłych pacjentów skierowanych na konsultację zaburzeń stawu skroniowo-żuchwowego do Instytuty Stomatologii, UJ w Krakowie zaproszono do uczestnictwa w badaniu. Pacjentów poddano badaniu w dwóch sesjach z odstępem dziesięciodniowym, które przeprowadziło dwóch niezależnych badaczy. Badaniem objęto: ruchy pionowe (niewspomagane odwodzenie bez bólu, maksymalne niewspomagane odwodzenie, maksymalne wspomagane odwodzenie), maksymalne ruchy poziome w lewo, w prawo i do przodu. Wyniki. Dla większości pomiarów, ICC były wyższe niż 0,75, co wskazuje na bardzo wysoką wiarygodność. Wniosek. Wiarygodność zakresu ruchu żuchwy wg. Polskiej wersji RDC/TMD jest porównywalna z innymi badaniami na świecie.Introduction. An important step in the implementation of the diagnostic criteria for scientific study is conducting reliability assessment of mandibular range of motion of the officially translated and culturally adapted Polish version of the RDC/TMD. Materials and Methods. A total of 123 adult patients who were referred for TMD consultation to the Dental Institute of Jagiellonian University in Cracow were invited to participate in the study. The patients were examined during two sessions with an interval of ten days by two examiners independently. The examination of the range of mandibular movements includes: vertical movements (i.e., unassisted opening without pain, maximum unassisted opening, maximum assisted opening), maximum horizontal movements to the left, to the right, and to the front. Results. For most measures, ICCs were larger than 0.75, which indicates excellent reliability. Conclusion. Reliability of mandibular range of motion of the Polish version of RDC/TMD is comparable with other world studies

Ezetimibe: New perspectives in lipid lowering treatment

Therapeutic goals for lipid lowering treatment in the prevention of ischemic heart disease are often not reached in clinical practice. Even the highest doses of statins do not guarantee good control of hypercholesterolemia in all patients. Therefore, new lipid lowering drugs are being investigated. One of them is ezetimibe - intestinal cholesterol absorption inhibitor. Treatment with ezetimibe results in significant reduction of total cholesterol and LDL cholesterol levels. It is hoped that concomitant treatment with ezetimibe and other lipid lowering drugs (particularly statins) will be more effective. In large randomized clinical trials, co-administration of ezetimibe with atorvastatin and simvastatin proved to be more effective in lowering cholesterol levels and reaching target therapeutic levels than treatment with statin alone. In addition, combined treatment with ezetimibe and simvastatin was more effective compared to treatment with today’s most effectively used statin (rosuvastatin) alone. Reduction of statin dose, due to the combined treatment with ezetimibe, lowers the risk of adverse events. Results of the published studies suggest that ezetimibe is safe and when administered together with statin does not increase the risk of liver or muscle damage. Treatment with ezetimibe may be regarded as a new option in the management of patients who need lipid lowering treatment. (Cardiol J 2007; 14: 232-237

Orthodontic and surgical treatment of a patient with an impacted upper central incisor with dilacerations : systematic review of the literature with presentation of a case

Introduction: Impacted upper central incisors are a big aesthetic, developmental and social problem for patients. One of the causes of tooth eruption is dilaceration, which is the angulation of the tooth root in relation to its crown. The prognosis regarding the possibility of introducing teeth with dilaceration to the dental arch is uncertain and is characterized by a large number of failures. The aim of the study was to conduct a systematic review of the literature discussing the subject of impacted upper central incisors with confirmed dilaceration and illustrate this problem with the presentation of our own clinical case. Objectives: The aim of the study was to conduct a systematic review of the literature discussing the subject of impacted maxillary central incisors with confirmed dilaceration and to illustrate this problem with the presentation of a clinical case. Material and methods: A systematic review of the literature was conducted by searching the medical databases of PubMed and Scopus. The search was carried out by entering the following keywords: dilaceration, impacted tooth, impacted maxillary central incisors. Non-systematic reviews of the literature were excluded from the analysis. Results: The result of searching the databases was a total of 706 articles. Twenty-nine articles corresponding to the objectives of the study were included in the analysis. Among them were original papers, meta-analyses and case reports. The problem of impacted upper central incisors with the diagnosed dilaceration is illustrated by the description of the orthodontic and surgical treatment of the case. Conclusions: Patients with diagnosed impacted tooth with dilaceration require detailed diagnostics to plan orthodontic treatment. The implementation of a comprehensive orthodontic and surgical treatment at an early stage of tooth development gives the best prognosis to introduce a tooth with dilaceration to the dental arch

Half of coronary patients are not instructed how to respond to symptoms of a heart attack

Background: The delayed treatment of acute coronary syndrome has a significant impact on survival. Due to improved organization and the use of reperfusion therapies, inhospital delay has been shortened in recent years. However, the time between the onset of chest pain and the call for medical help is still too long. The aim of this study was to assess the proportion of coronary patients instructed how to behave in case of chest pain and to find what factors relate to a lower probability of being counselled. Methods: Patients aged < 80 years, hospitalized due to coronary artery disease (CAD) were identified retrospectively on the basis of a medical records review and were invited for a follow-up examination. Two hundred and nineteen patients agreed to participate in the study. Data on the prehospital delay was obtained using a standard questionnaire. Results: The study group consisted of 149 men and 70 women. The mean time between discharge and the follow-up examination was 1.1 &#177; 0.4 years. Of 219 study participants, 106 (48.4%) declared they had been instructed about the symptoms of a heart attack and how to respond to it. Men, smokers, non-diabetics, and those with previously diagnosed CAD had been instructed more frequently. The independent predictors of being instructed were: percutaneous coronary intervention during the index hospitalization, diabetes, smoking, male sex and previously diagnosed CAD. Conclusions: About half of patients after hospitalization due to CAD are not instructed how to respond to heart attack symptoms. This has not changed over the last decade and may contribute to the lack of shortening of prehospital delay. (Cardiol J 2011; 18, 6: 668&#8211;674

Ezetymib - nowe perspektywy leczenia hipolipemizującego

W praktyce klinicznej nadal często nie osiąga się celów terapeutycznych dotyczących leczenia hipolipemizującego w profilaktyce choroby niedokrwiennej serca. Stosowanie nawet maksymalnych dawek statyn nie gwarantuje dobrej kontroli hipercholesterolemii u wszystkich chorych. Dlatego trwają poszukiwania nowych preparatów obniżających stężenie cholesterolu. Takim lekiem jest ezetymib, który hamuje wchłanianie cholesterolu w jelitach. Stosowany u osób z hipercholesterolemią powoduje istotne obniżenie stężenia cholesterolu całkowitego i cholesterolu frakcji LDL. Dzięki wynikom dużych randomizowanych badań klinicznych spore nadzieje wiąże się z połączeniem ezetymibu z innymi lekami hipolipemizującymi, zwłaszcza statynami. Połączenie ezetymibu z simwastatyną i atorwastatyną okazuje się skuteczniejsze niż monoterapia statyną w obniżaniu stężenia cholesterolu oraz osiąganiu docelowego stężenia terapeutycznego. Ponadto udowodniono większą skuteczność terapii skojarzonej simwastatyny z ezetymibem w porównaniu z monoterapią najskuteczniejszą ze stosowanych obecnie statyn - rosuwastatyną. Redukcja dawki statyny, dzięki dołączeniu do terapii ezetymibu, pozwala na zmniejszenie prawdopodobieństwa wystąpienia objawów niepożądanych związanych ze stosowaniem dużych dawek tych leków. Wyniki opublikowanych dotychczas badań sugerują, że ezetymib jest lekiem bezpiecznym, a jego jednoczesne podawanie ze statyną nie zwiększa ryzyka wystąpienia uszkodzenia wątroby czy mięśni. Należy uznać, że stosowanie ezetymibu daje nowe możliwości postępowania u pacjentów wymagających leczenia hipolipemizującego. (Folia Cardiologica Excerpta 2007; 2: 285-291

Knowledge on the guideline-recommended use of antiplatelet and anticoagulant therapy during dental extractions : a contemporary survey among Polish dentists

Background: The number of dental patients requiring periodic or lifelong antiplatelet or anticoagulanttherapy is constantly growing. Aims: We aimed to determine the level of knowledge on antiplatelet and anticoagulant therapy among Polish dentists. Methods: self‑designed online questionnaire was distributed among dentists to evaluate their knowledge on the use of antiplatelet and anticoagulant drugs in clinical dental practice. Results: The study included 352 dentists. Patients requiring vitamin K antagonists were referred for a cardiac consultation by 64.52%, 57.29%, and 58.55% of dentists with &lt; 5, 5–15, and &gt; 15 years of experience,respectively (P = 0.003). A similar trend was observed for non–vitamin K antagonist oral anticoagulants among nonsurgical dentists. However, an equal percentage of surgical dentists (39.7%) performedextraction with and without consultation, and they were more likely to perform extraction withoutconsultation than nonsurgical dentists (39.7% vs 27.8%; P = 0.01). Most surgical and nonsurgical dentistspreferred to consult a cardiologist about dual antiplatelet therapy before an invasive procedure (56.9%and 73.81%, respectively; P = 0.03). Extractions in patients on aspirin were accepted by 75.81%, 70.83%, and 49.34% of dentists with &lt; 5, 5–15, and &gt; 15 years of experience, respectively (P = 0.004), and by 79.31%of surgical and 57.14% of nonsurgical dentists (P = 0.003). Conclusions: Knowledge on antiplatelet and anticoagulant therapy in patients undergoing dental procedures is unsatisfactory among Polish dentists. Both therapies were discontinued before extractionsmore frequently than recommended in the guidelines, while extractions in patients on aspirin were common

Prevention of infective endocarditis during dental extractions among Polish dentists : a contemporary nationwide survey

Introduction: Infective endocarditis (IE) is a potentially life-threatening condition. According to current ESC (European Society of Cardiology) guidelines, the use of antibiotic prophylaxis should only be reserved for specifi c dental procedures with interruption of consistency of the oral mucosa such as extractions and should be reserved for patients with the highest risk of developing IE. The aim of this study was to assess the knowledge of need for IE prophylaxis indefined clinical settings among Polish dentists. Material and Methods: A specially self-designed internet questionnaire was created concerning the topic of infective endocarditis prophylaxis in specific clinical scenarios for patients undergoing dental extractions during outpatient visits. The survey was made available to the dentists via internet and was active in March 2018. Results: Th ere were 352 Polish dentists who completed the survey. Antibiotic prophylaxis for IE during dental extractions was used in 93% of cases with prior IE, 89% with artifi cial heart valve, 69% with biological valve, 28% with pacemaker, 54% with coronary stent, 73% with cyanotic heart defect, 58% with diabetes mellitus, 20% after prior myocardial infarction and 54% with heart valve disease. There was a significant relationship between the time of working as a physician (>15 years) and more outdated or improper IE prophylaxis (p = 0.04). Conclusions: The management of patients for infective endocarditis prophylaxis undergoing dental extractions is suboptimal. Antibiotic therapy is overused in some clinical scenarios and on the other hand underutilized in those recommended by the current ESC guidelines