Medical screening of dental patients: 16-year experience in a referral dental hospital

The lifespan of the average person has been significantly increased by the advances in medical technology such that the dental patient is likely to have medical conditions which may alter the outcome of dental treatment. This retrospective study aims at observing the prevalence of medical conditions according to age and sex in a referral dental institution over a 16-year period. The male:female ratio was 65:35; most patients were in the age group 40–60 years. Hypertension (12.5 %) and diabetes (7.5 %) were the commonest disorders observed in this study cohort. Others were heart disease, hematologic disorders, hepato-biliary diseases and neurologic diseases. Screening of dental patients for medical disorders is necessary to detect them and modify dental protocol accordingly. This article also provides dental treatment guidelines for patients with medical disorders. The reader should understand the determinants and indicators of systemic health which are essential for the development and promotion of programs designed to improve the screening of such patients. In future, increased emphasis can be laid on research and training in this growing field at dental schools and organized dentistry places like referral dental hospitals.     

A “Top Five” list for emergency medicine: a policy and research agenda for stewardship to improve the value of emergency care

United States health care costs are growing at an unsustainable rate; one significant contributor has been the overuse of health services. Physicians have a professional ethical obligation to serve as stewards of society’s resources and take responsibility for health care costs. We propose a framework for identifying overused services and a research and implementation agenda to guide stewardship efforts to demonstrate the value of emergency care. Examples of interventions to reduce the cost of emergency care along six value streams are discussed: laboratory tests, high-cost imaging, medication administration, intravenous fluids and medications, hospital admissions and post-discharge care. Structural and political hurdles such as the Emergency Medical and Active Labor Act mandate, medico-legal concerns, lack of provider knowledge about costs and economic conflicts are identified. A research agenda focused on identifying low value clinical actions and potential interventions for overuse reduction is detailed. A policy agenda is proposed for organized emergency medicine to convene a structured, collaborative process to identify and prioritize clinical decisions that are of little value to patients, amenable to improvement through standardization, and actionable by front-line providers. Emergency medicine cannot wait longer to identify areas of low value care, or else other groups will impose external standards on our practice. Development of a Top Five list for emergency medicine will begin to demonstrate our professional ethical commitment to our patients and health system improvement.     

The Management of Hypertension for an Acute Stroke: What Is the Blood Pressure Goal?

Stroke is the 4th leading cause of death in the US and a leading cause of disability among adults. Stroke is broadly classified into ischemic and hemorrhagic subtypes. Although the pathogenesis may differ between ischemic and hemorrhagic stroke subtypes, a unifying feature is that hypertension is a major risk factor for most ischemic and hemorrhagic strokes. Prevention of first and recurrent stroke is substantially dependent on blood pressure control. There is controversy about blood pressure management in acute stroke. In this review we discuss controversies about and guidelines for management of blood pressure in acute stroke. We subdivide our discussion to address important questions about acute blood pressure management in ischemic stroke, intraparenchymal hemorrhage, and subarachnoid hemorrhage. In addition, we address BP control recommendations when tissue plasminogen activator administration is being contemplated for treatment of acute ischemic stroke.     

Minimally Invasive Bipolar Fractional Radiofrequency Treatment Upregulates Anti‐Senescence Pathways

Background

The sirtuin gene family has been implicated in various anti‐senescence pathways. Its connection, if any, with the skin wound healing response has yet to be elucidated.

Objective

The goal of our study was to better understand the effects of FRF treatment on the sirtuin anti‐senescence pathway in skin.

Methods

Human abdominal skin was treated with FRF, and then harvested at 0, 2, 14, and 28 days post‐treatment to assess for temporal changes in gene expression levels.

Results

Decreased levels of SIRT1, 3, 5, and 7 were observed immediately post‐FRF treatment. By Day 2, SIRT1, 6, and 7 expressions increased 50–100%. SIRT6 and 7 expression continued to increase through Day 28. Expression levels of apoptosis genes FoxO3 and p53 decreased, while Bax levels increased by Day 28.

Conclusions

Our results raise the possibility that sirtuin activity may be used as an accurate corollary to clinical improvement in skin quality. Lasers Surg. Med. 9999:XX–XX, 2013. © 2013 Wiley Periodicals, Inc.     

Are frontal sinuses useful indicators of sex?

Accurate sex prediction of skeletonised human remains excludes one-half of the population, enabling a more focussed search of missing persons' files. The skull is useful in sex assessment of skeletonised remains; however, its fragmentation precludes the use of all conventional craniofacial markers. The frontal bone may be recovered intact in fragmented remains and the sinuses therein may be useful in sex differentiation. A total of 100 paranasal sinus view radiographs of 50 males and females each were evaluated for potential differences in frontal sinus configuration following the methods of Yoshino et al. (Forensic Sci Int 1987; 34:289–99.) and Tang et al. (Forensic Sci Int 2009; 183:104.e1–3.). Data were assessed through univariate and multivariate statistics. The univariate Mann–Whitney U-test revealed statistically insignificant sexual dimorphism (p > 0.05) for the frontal sinuses. Moreover, multivariate logistic regression equations allowed correct sex identification in 60% of cases only. Possible reasons for the low sexual dimorphism may be frontal sinus' high inter-individual variability; also, existing techniques that employ frontal sinus classification systems may lead to a loss of information when features that require visual observation are grouped and assigned class numbers. The results herein suggest that frontal sinuses may have limited application as the sole predictor of sex.     

Neuropsychiatric manifestations of typhoid fever

Neuropsychiatric manifestations of typhoid fever are not uncommon, occurring in 18 of 40 consecutive patients at the University Hospital of the West Indies. The clinical presentation ranges from a confusional state to hallucinations or meningism, and the diagnosis may be missed or unduly delayed unless there is a strong index of suspicion.     

Hypothyroidism renders protection against lethal ventricular arrhythmias in a conscious canine model of sudden death.

The protective effect of hypothyroidism against lethal ventricular tachyarrhythmias (VT) in the subacute phase of experimental myocardial infarction (MI) was investigated in 10 thyroidectomized dogs using a conscious model of sudden coronary death. Four weeks after surgical ablation of the thyroid, and having established biochemical hypothyroidism, anterior MI was produced by 120 min of occlusion-reperfusion of the left anterior descending coronary artery. In the subacute phase of MI, the inducibility of VT was investigated using programmed ventricular stimulation (PVS), and the effects on spontaneous development of ventricular fibrillation (VF) were studied by production of posterolateral ischemia at a site remote from the area of the previous infarction. Ischemia was produced by the passage of anodal direct current through a silver wire electrode implanted in the left circumflex coronary (LCX) artery. The results were compared to those from a cohort of 20 existing euthyroid controls that had undergone an identical experimental protocol. No differences were found in heart rate and other electrocardiographic parameters such as the PR, QRS, and QT (paced at 2.5 Hz) and the QTc interval between the hypo- and euthyroid groups. During PVS in the subacute phase of anterior MI, the measured threshold voltage and ventricular refractory periods were similar in both groups. The incidence of inducibility of VT was 100% in the euthyroid animals compared to 60% in the hypothyroid dogs, suggesting an antiarrhythmic effect of hypothyroidism. The incidence of sustained vs. nonsustained VT was similar in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)