Benefits and potential risks of bisphosphonate therapy: a narrative review

Bisphosphonates have been proven to be effective and safe to millions of osteoporotic and cancer patients but were associated with multiple complications. The most prevalent and well established are upper gastrointestinal discomfort for oral bisphosphonates and acute phase reactions for intravenous forms. Although rare, hypocalcaemia and renal injury could be potentially serious. Severe musculoskeletal pain and ocular events may be ignored by physicians, which delay their diagnosis and management. Recently there are growing concerns over two long-term and emerging adverse effects, which are still of unclear pathophysiology and unproven causality. Osteonecrosis of the jaw is more common in cancer sufferers who receive high doses of intravenous bisphosphonates. Atypical femoral fractures are very rare compared with osteoporotic fractures that bisphosphonates prevent. Based on current data, the association of bisphosphonates with esophageal cancer, hepatotoxicity and atrial fibrillation remains doubtful. Overall, the adverse effect profile of these drugs is still unclear. Physicians must be vigilant to bisphosphonate-reported side effects and recognize the level of evidence supporting them, to better communicate the balance between benefits and potential risks to patients

[Age determination of dental in forensic dentistry]

The study of the dentition is a common manner for age determination. In this article, we will discuss the pertinent methods to estimate the dental age of unknown dead or young alive people. In children, histological techniques as well as tooth eruption or calcification are appropriate to assess dental age inpostmortem. After 15 years, it becomes difficult to estimate the age, since the phenomena related to the tooth eruption or calcification is completed. Therefore, the rate of racemization and Lamendin method are pertinent to determine the age adults in postmortem. Finally, in young alive people where age determination has legal interest, the mineralization of the wisdom tooth is a fundamental criterion for evaluating dental age. The determination of age depends on physiologic, environmental, genetic and pathologic factor. Thus, the age estimation in Lebanese population might be appraised using the methods universally adopted after adjustment, to obtain an accurate evaluation

Oral and general health indicators for Lebanese elderly in oral surveys: review article

Various factors are taken into account in assessing objectively the dental status and the quality of life related to oral health, particularly in elderly. Basic socio-demographic characteristics and oral hygiene habits must be identified and screened, respectively. The dental health can be evaluated using indicators such as the ASA score or by determining the person's level of autonomy. Cognitive ability of older people must be checked prior to use oral health questionnaires. This competence can be assessed by the Mini Mental State score [MMS]. The use of Mini Nutritional Assessment [MNA] evaluates the nutritional status of patients. The aim of the article is to identify the most relevant indicators that can be used in epidemiological studies to assess the oral health of Lebanese elderly

Determinants of antibiotic use and throat culture in managing pharyngitis among primary health care physicians in Beirut

Studies have suggested that antibiotics are often inappropriately prescribed for the treatment of pharyngitis despite clinical evidence and international guidelines. This study examined the use of antibiotics by primary health care physicians [PHC] and their reliance on clinical factors in the decision to prescribe throat culture and antibiotics, as advocated by the Centers for Disease Control and Prevention [CDC]. A questionnaire was completed by 103 PHC physicians randomly selected and working in Beirut, Lebanon. Primary care physicians prescribed antibiotics to 42% of patients with pharyngitis, especially if patients consulted during winter v/s summer [68% v/s 38%; p < 0.01]. The most frequent symptoms and signs leading to antibiotic prescription and to throat culture in pharyngitis were tonsillar exudates, cervical adenopathy and fever. No physician used all the criteria in the score adopted by the CDC to decide on the prescription of antibiotic or throat culture. This study showed a high prescription rate of antibiotics and a lack of adherence to clinical guidelines by PHC physicians in the management of pharyngitis. Efforts to help physicians improve their practices should be implemented by the diffusion of international recommendations and the monitoring of practices