Admission Norton scale scores (ANSS) correlate with rehabilitation outcome and length in elderly patients with deconditioning

We sought to determine if admission Norton scale scores (ANSS) used for evaluating pressure ulcer risk also correlate with rehabilitation outcome and length in elderly patients with deconditioning. This was a retrospective study conducted in a geriatric department between June 2008 and June 2010. The medical charts of consecutive elderly (≥65 years) patients admitted for rehabilitation due to deconditioning were studied for the following measurements: ANSS, admission albumin serum levels, mini-mental status examination (MMSE) scores, discharge walking functional independence measure (FIM) scores, discharge transfer FIM scores, and rehabilitation length. The cohort included 152 patients: 79 (52%) females and 73 (48%) males. Mean age was 83.6±6.5 years. The three most common causes of deconditioning were pneumonia, congestive heart failure exacerbation, and falls. ANSS correlated with discharge walking FIM scores (r=0.32; p=0.003), discharge transfer FIM scores (r=0.30; p=0.005), and length of rehabilitation (r=-0.37; p<0.0001), following adjustment for age, albumin serum levels, and MMSE scores. Linear regression analysis showed that ANSS were independently associated with discharge walking FIM scores (p=0.004), discharge transfer FIM scores (p=0.006), and rehabilitation length (p<0.0001). We conclude that the Norton scoring system may be used for predicting the outcome and the length of rehabilitation in elderly patients with deconditioning.     

Advances in genetics show the need for extending screening strategies for autosomal dominant hypercholesterolaemia

Aims Autosomal dominant hypercholesterolaemia (ADH) is a major risk factor for coronary artery disease. This disorder is caused by mutations in the genes coding for the low-density lipoprotein receptor (LDLR), apolipoprotein B (APOB), and proprotein convertase subtilisin/kexin 9 (PCSK9). However, in 41% of the cases, we cannot find mutations in these genes. In this study, new genetic approaches were used for the identification and validation of new variants that cause ADH. Methods and results Using exome sequencing, we unexpectedly identified a novel APOB mutation, p.R3059C, in a small-sized ADH family. Since this mutation was located outside the regularly screened APOB region, we extended our routine sequencing strategy and identified another novel APOB mutation (p.K3394N) in a second family. In vitro analyses show that both mutations attenuate binding to the LDLR significantly. Despite this, both mutations were not always associated with ADH in both families, which prompted us to validate causality through using a novel genetic approach. Conclusion This study shows that advances in genetics help increasing our understanding of the causes of ADH. We identified two novel functional APOB mutations located outside the routinely analysed APOB region, suggesting that screening for mutations causing ADH should encompass the entire APOB coding sequence involved in LDL binding to help identifying and treating patients at increased cardiovascular risk.     

Salivary bacteria and oral health status in medicated and non-medicated children and adolescents with attention deficit hyperactivity disorder (ADHD)

Objectives

Attention deficit hyperactivity disorder (ADHD) is a childhood neurological disorder. Studies have shown that children with ADHD are more prone to caries than those without. The study investigated children diagnosed with ADHD, both with and without pharmacological intervention, and the following: DMFT\dmft, plaque index (PI), mutans streptococci (MS) levels, lactobacilli (LB) levels, salivary flow, salivary buffer capacity, oral hygiene, and diet.

Study design

DMFT/dmft index, PI, MS and LB levels, salivary flow, and salivary buffer capacity were examined in three groups of children: ADHD1—diagnosed with ADHD with no pharmacological intervention (N?=?31), ADHD2—treated with medications for ADHD (N?=?30), and a healthy control group (N?=?30). Diet and oral health habits were assessed through questionnaires completed by parents.

Results

There were no differences in the DMFT/dmft index, MS and LB counts, salivary buffer capacity, and parent reported diet and oral health behavior between the three groups. Children with ADHD demonstrated a higher plaque index.

Conclusions

Although children with ADHD did not report different diet and oral health behavior from children without ADHD, this group had significantly higher levels of plaque than the control group, which combined with hyposalivation may be a risk factor for caries at an older age.

Clinical relevance

Medicated and non-medicated ADHD children were similar to control children in their caries rate, MS and LB counts, salivary buffer capacity, and diet and oral health behavior. They differed in the amount of plaque found on their teeth. As a group, ADHD children demonstrated hyposalivation compared with the control.     

Genetics of rheumatoid arthritis: an impressionist perspective

Rheumatoid arthritis (RA) is the most common rheumatic disease. The genetic basis of RA is supported through the identification of more than 30 susceptibility genetic variants. Each of these genes individually makes only a slight contribution to the risk of disease. Moreover, there is significant disparity in the genetic variants associated with different RA subgroups and patient ethnicities, which emphasizes the intricate nature of the disease's pathogenesis, and the complexities involved in large-scale genetic studies. This review evaluates critically the recent literature on the genetic contribution to RA and assesses the methodology used to identify these risk alleles.     

Implant locating and placement based on a novel tactile imaging and registration concept: a technical note

Computed-assisted surgery (CAS) has been designed to improve oral implant planning and positioning and to increase safety and operator comfort. This is especially important in the esthetic zone, at sites with bone deficiency, and when minimally invasive implant placement is the therapy of choice. Current available CAS systems are relatively large and expensive and require a lengthy learning period. This report presents a novel tactile imaging and registration concept that enables the operation of a newly developed computerized implant locating system. An intraoral bone-sounding device maps the surface of the jaw through the soft tissue. Bone contour data are registered over the computerized tomographic image. Guided by treatment preplanning software, a chairside robotic manipulator fabricates guiding sleeves that direct the drill and implant during the osteotomy and implant placement, respectively. The authors' clinical experience shows that tactile registration based the Implant Locating System is simple to use and provides accurate implant design and placement that requires only basic computer experience, minimal operational space, and low infrastructure investment. The system allows final adjustments at the time of operation, transforming each implant surgery into a fully monitored procedure.