Absence of Supportive Periodontal Treatment during the Covid-19 Pandemic - Recurrence of Periodontal Inflammation

Case presentation: Supportive periodontal care (SPC) is defined as step IV by the 2020 and 2022 EFP Guidelines for the treatment of periodontitis stages I-IV. SPC aims to maintain periodontal stability after active periodontal treatment is finished and the endpoints of periodontal therapy are achieved. SPC presumes preventive and therapeutic procedures performed at individualised, patient-based intervals. This case report describes a patient, 43 y/o female, with diagnoses of generalised periodontitis stage IV, grade C and periodontal health on reduced periodontium who was enrolled in longterm SPC provided at 3 - 4-monthly intervals. During the COVID-19 pandemic, the patient did not report for regular SPC due to personal fears of the contagion. After 20 months of absence, the patient was admitted for SPC. The comprehensive periodontal exam showed excellent oral hygiene (FMPS=7%), the presence of five 4 and 5 mm pockets and relapse of periodontal inflammation (FMBS=42%). The affected areas were mostly in the lower jaw. As periodontitis is a chronic disease, patients need to be continuously monitored. SPC reduces the probability of disease progression and tooth loss, as timely re-treatment can be provided in cases of disease recurrence. Various factors can contribute to disease relapse. In terms of the described patient, despite good oral hygiene, factors such as psychological stress and unhealthy living habits experienced during the COVID-19 pandemic might have negatively impacted the innate host response and led to disease relapse.

Therapeutic Plasma Exchange to Alleviate Ventricular Tachycardia after Diphenhydramine Ingestion

INTRODUCTION: The Covid-19 pandemic has adversely affected the mental health of children causing an increased incidence of suicide attempts. Diphenhydramine is a common household medication and is frequently ingested by children. Toxic doses of diphenhydramine can affect the cardiovascular and central nervous system. In the heart, diphenhydramine blocks fast sodium channels and potassium channels which can result in conduction abnormalities including sinus tachycardia, widening of QRS duration, ventricular tachycardia and torsades de pointes. Massive ingestion can cause severe cardiovascular collapse which may require ECMO support. We describe the case of a patient with diphenhydramine ingestion and refractory ventricular arrhythmias that was successfully treated with therapeutic plasma exchange (TPE). DESCRIPTION: A 13-year-old female with history of depression presented with confusion following an intentional ingestion of 1500 mg of diphenhydramine. On admission, she had frequent PVC's, bigeminy, ventricular couplets and a run of non-sustained polymorphic ventricular tachycardia with pulse despite magnesium and sodium bicarbonate. She converted to normal sinus rhythm spontaneously but continued to have frequent PVC's and prolonged QTc. Shortly thereafter, her rhythm deteriorated to non-sustained monomorphic ventricular tachycardia with a pulse which was treated with calcium gluconate, sodium bicarbonate and intralipid infusion. Due to refractory hypotension and refractory arrhythmia, we offered TPE to remove plasma protein bound drug molecules from circulation. We performed a 1.7 plasma volume TPE using 5% albumin as a replacement fluid. The serum level of diphenhydramine decreased from 1300 ng/ml to 770 ng/ml. The patient's hemodynamics improved, and she did not have any further arrhythmias. DISCUSSION: Diphenhydramine toxidrome is usually managed with medical therapy and ECMO if needed for hemodynamic support. TPE is traditionally not performed in this clinical setting as the data regarding its utility is limited. The decrease in drug levels before and after TPE treatment was associated with improvement in the patient's hemodynamics and rhythm. This case report is unique because, to the best of our knowledge, the use of TPE in diphenhydramine toxicity has not been reported in medical literature.

Dental students' perception and attitudes about the impact of the COVID-19 pandemic on the practical training and clinical work

Background and Aim: Coronavirus pandemic has caused unpredictable changes in dental education and healthcare system worldwide. In March and April 2020 due to the COVID - 19 outbreak, University of Dental medicine Zagreb, Croatia, temporary closed its door to its students. However, theoretical parts of the curriculum were held online, but practical training was canceled to reduce the risk of infection. This research aimed to assess student's attitudes and perception towards importance of practical training and their preparedness for the work as a clinician. Methods: This cross-sectional observational study was conducted using an online survey on a population of undergraduate students enrolled in academic year 2019/20. Results: 352 students participated and completed the survey. 186 students (65%) were students who were supposed to start clinical courses of which 52 (14.3%) were students of the last year of the school. The loss of clinical courses in summer semester of the academic year 2019/20 will not affect preparedness and self-confidence when working with patients in only 5.2% students of 4th and 5th year. Regardless of the extraordinary period caused by the pandemic, 56.7% students of 4th and 5th year and 46.2% students of the last year are looking forward to start clinical courses and work with patients. However, fear and discomfort with regards to start to work with patients at a time of a pandemic felt 9.6% students of the last year. Conclusions: Practical courses that were canceled because of emergency measures impacted on all of students, especially the ones who were about to start with clinical work. Although practical skills are trained on mannequins as well, working with patients is irreplaceable part of education for future dentists.

Teaching during the COVID-19 pandemic

Objectives. The purpose of the study was to assess students opinion and attitudes towards online teaching during the period of emergncy measures in summer semester of the academic year 2019/2020 caused by the COVID- 19 pandemic. Materials and methods. The study was performed by means of an annonimous questionnaire. The questionnaire consisted of a few parts that questioned students sociodemographic status, attitudes and opinion of online teaching. The data were statistically processed using SPSS software. Results. Of the total of 357 respondents, 13.1% were first year students, 19.0% second, 15.1% third, 17.9% fourth, 20.2% fifth and 14.8% last year of schooling. More than 60% reported feelings of insecurity and fear due to introduction of emergency measures in the Republic of Croatia. More than 17% found studying harder than usually, and 19.3% were not equally motivated to study. 8% of the respondents found adaptation in knowledge assessment (with PPE -gloves and face masks) as a source of stress and 13% reported taking online exams at homes stressfull. 20 % reported that suspension of practical courses affected their knowledge during knowledge assessments and 16% would master the curriculum more successfully in direct contact with the teacher. More than 88% reported awareness of risk associated with dental profession due to COVD- 19 pandemic outbreak. Conclusion. Due to uncertainty caused by the COVID-19 pandemic, lectures and prac- tical courses were held online. The results given indicate online lectures are as valuable as on-site lecture and suspension of practical courses cant be fully compensated.