Opportunities for Virtual Care in Eosinophilic Esophagitis: Real-World Dietary Therapy Practice

Introduction: Dietary therapy for eosinophilic esophagitis (EoE) is an effective first-line treatment aimed at identifying triggers by systematically removing then reintroducing food groups. Success on diet therapy can be augmented by working with a dietitian, but this is not a universal clinical resource. Virtual or telehealth approaches to nutrition care may offer opportunities to implement diet therapy for EoE. We conducted a retrospective study at a tertiary center with six GI dietitians to compare real-world standard in-person versus virtual EoE nutrition practices in terms of access, follow-up< and disease control. Method(s): We identified adults with EoE referred to GI nutrition through query of the electronic medical record by ICD-10 diagnoses and confirmed by chart review. As all nutrition visits prior to the COVID pandemic were performed in-person, standard care was defined as care established in January-December 2019 and virtual care in January-December 2021. Associations were analyzed using Chi-squared and Student's t test (Table). Result(s): A total of 204 patients were included;99 referred for standard in-person and 105 virtual nutrition care. The cohorts did not differ significantly by gender, age at the time of referral, race, and distance lived to our center. Of these, 55.6% (55) standard and 48.6% (51) virtual visits were completed with a dietitian (p=0.341) and 4-food elimination diet was the most commonly planned diet. The majority initiated the diet (80.0% standard, 78.4% virtual, p=0.842) and among them, half successfully attained histologic remission with the elimination phase (63.6% standard, 47.5% virtual, p=0.324). Ultimate treatments plans included remaining on dietary therapy (25.5% standard, 23.5% virtual, p=0.728), no treatment or lost to follow-up (34.6% standard, 25.5% virtual), and medication (25.5% standard, 41.2% virtual). Conclusion(s): There is a growing demand for nutrition care in EoE and in our tertiary practice, we found no differences in the success and response rate on elimination diet or follow-up between patients receiving standard or virtual nutrition care. Virtual approaches to implementing EoE dietary therapy may serve to complement in-person care and offer opportunities for those lacking local dietitian access. However, up to one-third of patients are lost to follow-up or remain untreated, also highlighting a need to identify, understand, and overcome barriers to treatment uptake and disease control .

Diagnosis of COVID-19: Considerations, controversies and challenges.

Coronavirus disease 2019 (COVID-19) due to a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global pandemic that has resulted in over 1.5 million confirmed cases and close to 100 000 deaths. In the majority of symptomatic cases, COVID-19 results in a mild disease predominantly characterised by upper respiratory tract symptoms. Reverse transcription polymerase chain reaction (RT-PCR) using a nasopharyngeal sample is the mainstay of diagnosis, but there is an ~30% false negative rate early in the disease and in patients with mild disease, and therefore repeat testing may be required. RT-PCR positivity can persist for several days after resolution of symptoms. IgM and IgG antibody responses become positive several days after the onset of symptoms, and robust antibody responses are detectable in the second week of illness. Antibody-based immunoassays have a limited role in the diagnosis of early symptomatic disease. However, their incremental benefit over RT-PCR in the first 2 weeks of illness is currently being clarified in ongoing studies. Such assays may be useful for surveillance purposes. However, their role in potentially selecting individuals who may benefit from vaccination, or as a biomarker identifying persons who could be redeployed into essential employment roles, is being investigated. Rapid antibody-based immunoassays that detect viral antigen in nasopharyngeal samples are being developed and evaluated.

COVID-19 Vaccines: Vagaries and Vacillations

All healthcare workers, including dental professionals are foot soldiers in the battle against the COVID-19 pandemic. Indeed, in the USA, dental practitioners and dental students are now recruited to deliver COVID-19 vaccines to the general population to expedite vaccine uptake, and rapidly suppress the pandemic. There are many unknowns in the evolving COVID-19 vaccine story, although we now see the true situation in a better light, with the rapid emergence of data from numerous countries, including UK, where the vaccine has currently been administered to millions. The situation is further compounded by the reported vagaries of the increasing number of brand-name vaccines, manufactured on both the new and old vaccine platforms, the purported or real, vaccine adverse effects, the emergence of possible vaccine-resistant viral variants, and the resultant low vaccine uptake due to vacillating public opinion. In this COVID-19 Commentary, we provide an update on the efficacy of the vaccines and the prevalence of adverse effects, as well as a summary of useful information for dental care workers on vaccine protocols appertaining to special situations, as promulgated both by the UK Committee on Vaccination and Immunisation, and the US Advisory Committee on Immunization Practices (ACIP). © 2021 George Warman Publications. All rights reserved.

SARS-CoV-2, and disinfectants and antiseptics in dentistry

Antiseptics and disinfectants are an integral part of our life in the 'new normal' era. How much do we know of these chemicals, some of which are rather toxic, and may even reduce fertility on prolonged exposure? In this COVID-19 commentary, the authors evaluate the quality of the commonly used disinfectants and antiseptics in dentistry, with particular emphasis on their virucidal activity. © 2020 George Warman Publications. All rights reserved.