Halitosis and periodontal disease in subjects with mental disabilities

Objective:  The aim of this study was to investigate the relationship between halitosis, presence of N -benzoyl-DL-arginine-2-naphthylamide (BANA) positive activity (indicative of Treponema denticola , Porphyromonas gingivalis , Tannerella forsythensis ) and periodontal conditions in subjects with mental disabilities.
Materials and methods:  The population consisted of 17 Down syndrome (DS), 17 mentally retarded (MR) and 17 mentally healthy subjects (MH) – control group. A portable sulfide monitor was used to measure the concentration of volatile sulfur compounds (VSC) found in the mouth. Clinical parameters [Plaque Index (PlI), Probing Depth (PD), Bleeding on Probing (BOP)] were obtained from six reference teeth. Subgingival plaque samples for BANA Test were taken from the same six teeth and dorsum of the tongue.
Results:  PlI and BOP were higher in DS than in MR and MH, respectively ( P  < 0.05). Mean PD was similar between DS and healthy groups but it was higher than the MR group. No significant differences were found among the three groups regarding the presence of BANA positive species, however the VSC levels were significantly lower in DS (97.23 ppb) than in MR (203.23 ppb) and MH individuals (180.53 ppb).
Conclusions:  Even though the presence of BANA positive activity was similar among DS, MR and MH subjects, halitosis seemed to be lower in the DS group.     

P8 Halitosis and periodontal disease in subjects with mental disabilities

Patients with complaints of halitosis do seek treatment from physicians and dental practitioners, because of the fear that their halitosis may interfere with their social activities. Although the prevalence of halitosis has been reported to be as high as 50%, most physicians and dental practitioners are poorly informed about the causes and treatments of halitosis. In order to care for patients with complaints of halitosis a multidisciplinary team was established at the Erasmus Medical Centre, Rotterdam, The Netherlands. The team included a dental hygienist, an otorhinolaryngologist, and a dentist, who developed a special halitosis programme. One short press release regarding the establishment of the team, was provided to the national press-centre. In the out-patient clinic more than 700 patients were seen by the team. Using a structured questionnaire fed to a PC, patients answered questions regarding complaints about the oral cavity, the upper respiratory tract, the throat, their general health, their cleansing habits of the oral cavity, and prior experiences with general physicians, dental practitioners, and medical specialists. They underwent examinations of the extent of their halitosis, of the perioral and neck region, the oral cavity, the upper respiratory tract, and the upper digestive tract. Finally, the members of the team came to a joint diagnosis and a joint treatment plan for every individual patient. Of the first 700 consecutive patients 57% were women. More than 80% were between 20 and 59 years old. One-third reported that they were never having breakfast or ate only soft food in the morning. Only 2% were diagnosed as having chronic sinusitis, 11% as having pharyngitis, 3% as having laryngitis, and 3% as having tonsillitis.     

COMPREHENSIVE SURGICAL MANAGEMENT OF ARTHRITIC KNEE

Total knee arthroplasty is not the only available surgical option for arthritic knees. It varies according to patient''s age and severity of the disease. 105 arthritic knees were surgically treated at the Joint Replacement Centre of Army Hospital (R&R) in last 4 years. 77 knees were osteoarthritic and 28 were rheumatoid. 24 of these were treated by arthroscopic debridement, 7 underwent unicondylar knee replacement and 74 underwent total knee replacement using Freeman Samuelsun (F/S) or Low Contact Stress (LCS) implants. The indications, contraindications, results and complications of these procedures are discussed.KEY WORDS: Arthroscopic debridement knee, Knee arthroplasty, Osteoarthritis, Rheumatoid arthritis, Unicondylar knee replacement     

Fulminant Staphylococcus lugdunensis septicaemia following a pelvic varicella-zoster virus infection in an immune-deficient patient: a case report

INTRODUCTION: the deadly threat of systemic infections with coagulase negative Staphylococcus lugdunensis despite an appropriate antibiotic therapy has only recently been recognized. The predominant infectious focus observed so far is left-sided native heart valve endocarditis, but bone and soft tissue infections, septicaemia and vascular catheter-related bloodstream infections have also been reported. We present a patient with a fatal Staphylococcus lugdunensis septicaemia following zoster bacterial superinfection of the pelvic region. case presentation: a 71-year old male diagnosed with IgG kappa plasmocytoma presented with a conspicuous weight loss, a hypercalcaemic crisis and acute renal failure. After initiation of haemodialysis treatment his condition improved rapidly. However, he developed a varicella-zoster virus infection of the twelfth thoracic dermatome requiring intravenous acyclovir treatment. Four days later the patient presented with a fulminant septicaemia. Despite an early intravenous antibiotic therapy with ciprofloxacin, piperacillin/combactam and vancomycin the patient died within 48 hours, shortly before the infective isolate was identified as Staphylococcus lugdunensis by polymerase chain reaction. CONCLUSION: despite S. lugdunensis belonging to the family of coagulase-negative staphylococci with an usually low virulence, infections with S. lugdunensis may be associated with an aggressive course and high mortality. This is the first report on a Staphylococcus lugdunensis septicaemia following a zoster bacterial superinfection of the pelvic region.     

The H-Wave® device is an effective and safe non-pharmacological analgesic for chronic pain: a meta-analysis

INTRODUCTION: This meta-analysis was conducted to systematically review the efficacy and safety of the H-Wave(R) (Electronic Waveform Lab, Inc, Huntington Beach, CA, USA) device and programme as a non-pharmacological analgesic treatment in chronic soft tissue inflammation and neuropathic pain. METHODS: Five studies related to pain relief, reduction in pain medication and increased functionality obtained with the H-Wave device were included in the analysis. Data were analysed using the random effects model, including adjustment to evaluate variability, size of study and bias in effect size. A total of 6535 participants were included in the meta-analysis; there were 8065 participants' outcomes measured due to multiple measurements per participant. RESULTS: The H-Wave device decreased pain ratings across various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.59, and the estimated effect size variance was 0.00003 (95% confidence intervals [CI]: 0.580, 0.600). The H-Wave device also decreased the intake of pain medication in patients with various chronic soft tissue inflammation and neuropathic pain conditions. The mean weighted effect size was 0.56, and the estimated effect size variance was 0.000013 (95% CI: 0.553, 0.567). Patient functionality was also improved with use of the H-Wave device. The mean weighted effect size was 0.70, and the estimated effect size variance was 0.00002 (95% CI: 0.691, 0.709). A chi-square test for homogeneous effect sizes found highly significant (P<0.00001) variability, indicating a robust significant effect size for increased functionality relative to both pain relief and reduction in pain medication. There was little to no evidence of any adverse effects associated with the use of the H-Wave device. CONCLUSION: The findings indicate a moderate to strong effect of the H-Wave device in providing pain relief, reducing the requirement for pain medication and increasing functionality. The most robust effect was observed for improved functionality, suggesting that the H-Wave device may facilitate a quicker return to work and other related daily activities.