Ludwig’s Angina in A Rural Hospital- An Infection Spreads from Dental Caries

@#Ludwig's angina is one of the emergency cases associated with impending upper airway obstruction. Through this case report, the neglected case of emergency medical diagnosis could be prevented and it will become a piece of evidence for the great importance of collaboration among clinicians. A 17-year old boy admitted to the emergency setting of a rural public hospital, East Belitung, Indonesia with major complaints of progressively swallowing difficulty and breathlessness with fever and chills for two weeks before hospital admission. There was a history of dental caries in mandibular right second molar. Non-surgical and surgical management has been conducted immediately and the patient was discharged after day three postoperatively. In this rural hospital setting, early and proper management based on accurate diagnosis is a pivotal step to prevent medical negligence amid limited resources and equipment.

Uso de antibióticos sistêmicos adjuntos à raspagem e alisamento radicular no tratamento da periodontite crônica e periodontite agressiva: uma revisão integrativa da literatura / Use of systemic antibiotics as an adjunct to scaling and root planing in the treatment of chronic periodontitis and agressive periodontitis: an integrative review

A periodontite é uma doença inflamatória crônica que atinge os tecidos de suporte dos dentes. O tratamento padrão consiste na redução do biofilme subgengival através da raspagem e alisamento corono-radicular associada às medidas de higiene oral. Entretanto, em indivíduos com periodontite agressiva ou periodontite crônica severa, pode ser necessário associar antibióticos ao tratamento periodontal não-cirúrgico para que ocorra uma melhora significativa dos parâmetros clínicos periodontais, tais como profundidade de sondagem e nível de inserção clínica. O objetivo desta revisão integrativa da literatura foi avaliar as estratégias terapêuticas antimicrobianas indicadas no tratamento das periodontites crônica severa e agressiva. A busca bibliográfica foi realizada nas bases de dados Pubmed e Scopus. Os descritores utilizados foram: “Chronic Periodontitis” AND “Agressive periodontitis” AND “periodontal debridement” OR “Dental Scaling” AND “Root Planing” AND “Anti-bacterial Agents” OR “Anti-infective Agents”.Foram incluídos ensaios clínicos em humanos, randomizados, controlados, duplo ou triplo cegos, em inglês, publicados entre janeiro de 2010 e março de 2015. Os resultados demonstraram que apesar do uso adjunto de antimicrobianos à raspagem e alisamento radicular, principalmente a associação de Amoxicilina com Metronidazol, ser eficiente na melhora das condições periodontais, há uma grande heterogeneidade em relação às doses e o tempo de seguimento dos antibióticos indicados em Periodontia. Também há dúvidas sobre o momento certo de iniciar a terapia medicamentosa. Dessa forma, há a necessidade de elaboração de protocolo (s) clínico (s) para o uso de antibióticos sistêmicos adjuntos ao tratamento periodontal

Periodontitis is a chronic inflammatory disease that affects the supporting tissues of the teeth. The periodontal treatment consists of modifying the subgingival biofilm by scaling and root planing associated with changes in oral habits. These procedures are sufficient in order to reach an adequate control of the disease in most patients. However, in patients with advanced periodontitis or chronic periodontitis, it is necessary to combine antibiotics to non-surgical periodontal treatment to improve clinical periodontal parameters such as probing depth and clinical attachment level. Thus, the objective of the research was to evaluate the anti-infective therapeutic strategies for the treatment of advanced chronic periodontitis and aggressive periodontitis. It is an integrative literature review. The articles were obtained from PubMed and Scopus databases. The keywords used in the search were “Chronic Periodontitis “AND” Aggressive periodontitis “AND” periodontal debridement “OR” Dental Scaling” AND “Root planing” AND” Anti -bacterial Agents” OR” Anti-infective Agents”. Controlled, randomized, double or triple blind clinical trials in humans, published between January 2010 and March 2015, were included. The results show that the adjunctive use of antibiotics to scaling and root planning, mostly the combination of amoxicillin plus metronidazole, was very effective in improving periodontal conditions, however it lacks optimum dose definition, duration of therapy and the best moment of antibiotic administration.In conclusion, a clinical protocol for the use of systemic antibiotics as an adjunct to periodontal treatment should be developed.

Photodynamic therapy - A strategic review.

Mechanical removal of the biofilm and adjunctive use of antibacterial disinfectants or various antibiotics have been conventional methods of the periodontitis therapy. There has been an upsurge of bacterial strains becoming resistant due to the injudicious use of antibiotics, recently. As a result there is pronounced interest and keenness in the development of alternate antimicrobial concepts. As the scientific community seeks alternatives to antibiotic treatment, periodontal researchers have found that photodynamic therapy (PDT) is advantageous to suppress anaerobic bacteria. Hence, PDT could be an alternative to conventional periodontal therapeutic methods. This review elucidates the evolution and use of photo dynamic therapy. The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. Even though PDT is still in the experimental stages of development and testing, the method may be an adjunct to conventional antibacterial measures in periodontology. PDT application has an adjunctive benefit besides mechanical treatment at sites with difficult access. Necessity for flap operations may be reduced, patient comfort may increase and treatment time decrease. Clinical follow-up studies are needed to confirm the efficacy of the procedure.

A Prospective Study of Intraocular Candidiasis

Intraocular fungal infection, especially due to candida infection, has become an increasingly important cause of nosocomial infectio. Despite increasing awareness of this complication of candidemia, serious visual impairment due to candida infection remains as a problem. For the determine the frequency of intraocular candidasis and evaluation of risk factor, patients with candidemia were evaluated with indirect ophthalmoscopic examination within ninety six hours ater blood culture. Intraocular candidiasis were found in thirty three Percent of patient with candidemia. Candida chorioretiritis were found in five (27%) patients, candida endophthalmitis was found in one (5%) patients. The candida chorioretinitis was not progressed to candida endophthalmitis in one patients. That patient with candida endophthalmitis was treated with intravitreal amphotericin B injection, pars plana vitrectomy. Among the six intraocular candidiasis patients, five patients got cnadidiasis after long term antibiotics therapy for flame burn injury and one after anticancer therapy combined with intravenous hyperalimentation. The risk factors for the development of intraocular candidiasis can be long-term antibiotic therapy, parenteral hyperalimentation, use of indwelling catheter, or use of immunosupressive drugs in our cases.

Clinical Observation on Postoperative Endophthalmitis Following Cataract Surgery

Postoperative endophthalmitis following cataract surgery is rare but may influence the final visual outcome markedly. The authors reviewed the clinical records of 16 patients who had been treated with the diagnosis of endophthalmitis after cataract surgeries from March. 1992. to September, 1995. We analysised their final visual outcomes according to cultured microorganisms, durations of symptom onset after the surgeries, the methods of antibiotic administration and treatment methods with or without vitrectomies. Final visual accuities were 0.5 or better in 50% of all eyes, 0.15 or better in 75% and light perception or worse in 4 eyes(25%). Twelve(75%) of all eyes were cultured in positive. Five of twelve culture proven cases were Staphylococcus epidermidis and five were Pseudomonas aeruginosa. Each case of Xanthomonas maltophilia and fluorescens were cultured. All 5 cases infected by gram positive organisms had got visual accuity of 0.15 or better but 4 of 7 eyes infected by gram negative ones had got. We treated 9 patients with intravitreal, subconjunctival and systemic antibiotics but did 7 without systemic antibiotics. Six cases(85.7%) of these had got visual accuity of 0.15 or better but 6 cases(66.7%) of those had got. One of five patients who had undergone therapeutic vitrectomies had got visual outcome of 0.15 or better but all eleven without vitrectomy had got.