Alopecia and Periodontitis: Exploring the connecting dots.

Alopecia areata is a systemic disease with nonscarring hair loss from the scalp, face, or any part of the body. The disease with undetermined etiology and pathogenesis has a considerable impact on the social life of patients which gradually builds up stress and expedites further deterioration of their condition. Interestingly, in such patients, besides stress-relieving exercises and immunomodulators, well-timed dental assessment and prompt treatment have contributed to improving the prognosis of alopecia. This depicts an interrelationship between alopecia and oral foci of infections. Over the past few decades, periodontitis has remained to be one of the predominant forms of oral focus of infection for systemic diseases. The present review throws light on the role of stress and autoimmunity in establishing a possible correlation between alopecia and periodontitis. It is augmented with documented case reports, demanding a complete oral examination in patients with the unexplained origin of alopecia. An interdisciplinary approach is the need of the hour which can prevent the progression of both the diseases as well as other oral infections.

Diagnostic yield of dual-phase computed tomography enterography in patients with obscure gastrointestinal bleeding and a non-diagnostic capsule endoscopy.

BACKGROUND AND AIM: In patients with obscure gastrointestinal (GI) bleeding, capsule endoscopy is widely used to determine the source of bleeding. However, there is currently no consensus on how to further evaluate patients with obscure GI bleeding with a non-diagnostic capsule endoscopy examination. This study aims to determine the diagnostic yield of dual-phase computed tomographic enterography (CTE) in patients with obscure GI bleeding and a non-diagnostic capsule endoscopy. METHODS: Patients with obscure GI bleeding who were referred for capsule endoscopy were prospectively enrolled. Obscure GI bleeding was defined as overt if there was obvious GI bleeding; otherwise it was defined as occult. Patients with a non-diagnostic capsule endoscopy and no contraindications underwent a CTE. RESULTS: Capsule endoscopy was performed in 52 patients; 26 patients (50%) had occult GI bleeding and 26 patients (50%) had overt GI bleeding. CTE was then performed in 25 of the 48 patients without a definitive source of bleeding seen on capsule endoscopy. The diagnostic yield of CTE was 0% (0/11) in patients with occult bleeding versus 50% (7/14) in patients with overt bleeding (P < 0.01). Using clinical follow up as the gold standard, for the 25 patients with a non-diagnostic capsule, CTE had a sensitivity of 33% (95% confidence interval 0.15, 0.56) and a specificity of 75% (95% confidence interval 0.22, 0.99). CONCLUSIONS: In patients with a non-diagnostic capsule endoscopy examination, CTE is useful for detecting a source of GI bleeding in patients with overt, but not occult, obscure GI bleeding.

Universal health care and reform of the health care system: views of medical students in the United States.

PURPOSE: Nearly 46 million Americans did not have health insurance in 2004. Recent studies have documented physicians' support for various remedies, including universal health care. The authors undertook this study to assess medical students' views on these topics. METHOD: In 2002, the authors surveyed a national random sample of first-year and fourth-year medical students (from the American Medical Association Masterfile) to determine their views about health care reform options, including universal health care. Response data were weighted and compared using chi-squared tests; statistical significance was set at p < or = .05. RESULTS: Of 1,363 medical students, 770 completed the questionnaire (response rate = 56.5%). In rating the importance of several health care issues, more than 80% of both first-year and fourth-year students rated the expansion of health care coverage as important. Nearly all first-year (90%) and fourth-year (88%) students agreed with the statement, "Everyone is entitled to adequate medical care regardless of ability to pay." Most students favored health care reform that would achieve universal health care, with first-year students (70%) somewhat more likely than fourth-year students (61%) to support universal health care (p = .012). Students were less likely to believe that physicians support universal health care, and more likely to believe that the public does. CONCLUSIONS: Both groups of students generally support the expansion of health coverage to the uninsured and some form of universal health care. This may be relevant both to policymakers in their considerations of health care reform and to medical educators concerned with teaching students about health policy issues.

Incomplete capsular bag distension syndrome after neodymium:YAG capsulotomy.

We report a 60-year-old man with incomplete capsular bag distension syndrome 2 years after neodymium:YAG (Nd:YAG) laser capsulotomy for capsule opacification, which developed from extracapsular cataract extraction with intraocular lens (IOL) implantation performed 4 years before presentation to our clinic. The patient reported floaters of 15 days duration. Slitlamp examination showed shallowing of the inferior and medial anterior chamber. Dilated pupil examination showed a peripheral capsular bag inferiorly and medially behind the IOL. The bag was distended and filled with turbid fluid. The central and superior capsule was absent as a result of the previous Nd:YAG treatment. The IOL lie over the anterior capsule, and peripheral capsule leaves' edges were adhered. An Nd:YAG laser puncture of the incomplete capsular bag resolved the condition.

Progress and pitfalls in underrepresented minority recruitment: perspectives from the medical schools.

PURPOSE: To assess current initiatives at U.S. medical schools to recruit underrepresented minorities (URM) and to identify perceived barriers to enrollment of URM students. METHODS: We developed a survey that was mailed to the dean of Student Affairs of all U.S. allopathic and osteopathic medical schools in 2002. Respondents were asked to list their schools' URM recruitment programs and rate the effectiveness of these programs. They were also asked to indicate barriers to URM recruitment from a list of 37 potential barriers and rate their overall success with URM recruitment. RESULTS: The study had a 59% response rate. All schools reported a wide variety of initiatives for URM recruitment with > or =50% of all schools using each of the 11 strategies. The three most commonly listed barriers to URM recruitment were MCAT scores of applicants (90%), lack of minority faculty (71%) and lack of minority role models (71%). Most schools rated their recruitment efforts highly; on a scale of 1 to 10 (10 being very successful), the average score was an 8. CONCLUSION: While schools continue to invest tremendous efforts in recruiting minority applicants, admissions criteria, lack of URM faculty and the need for external evaluation remain important barriers to achieving a diverse physician workforce.

Medical students' knowledge of the U.S. health care system and their preferences for curricular change: a national survey.

PURPOSE: To measure medical students' knowledge of central issues in the U.S. health care system and to understand their perception of the importance and quality of health policy curricula at their medical schools. METHOD: A questionnaire was developed using facts from recent national and international health reports to test students' knowledge of health policy. The instrument, containing 14 questions about health policy and four questions about school curriculum on health policy, was mailed to a national probability sample of 516 first-year and 847 fourth-year students in the United States. Chi-square and t tests were used to compare the responses of first- and fourth-year students. RESULTS: A total of 295 first-year (57%) and 475 fourth-year students (56%) responded. Nearly all respondents were aware of the adverse health consequences for the uninsured, but 40% of first- and fourth-year students underestimated the numbers of uninsured in the United States. Thirty-two percent of respondents incorrectly answered that the United States had the highest life expectancy of any nation, and 27% were not aware that the United States has the highest health cost per-person of any nation. First- and fourth-year students performed similarly on knowledge questions. Ninety-six percent of respondents felt that knowledge of health policy is important to their career, and 54% expressed dissatisfaction with the health policy curriculum in medical school. CONCLUSION: Medical students have significant gaps in knowledge concerning the U.S. health care system. Most students perceive that these deficiencies are not adequately addressed in the medical school curriculum.

Colon cancer screening strategies.

PURPOSE OF REVIEW: Screening and prevention of colorectal cancer is a public health priority. Fecal occult blood testing is a popular screening test because of its simplicity, noninvasiveness, and demonstrated mortality benefit. At the same time, guaiac tests suffer from poor sensitivity, limited ability to detect early lesions, the need for annual testing, low population compliance, and high costs of follow-up for false-positive tests. These limitations have sparked many innovations in stool testing. RECENT FINDINGS: Recent studies suggest that both community intervention and physician awareness are needed to improve patient compliance with fecal occult blood testing and colorectal cancer screening in general. Despite the low costs of the guaiac test, the high false positives and high false negatives of fecal occult blood testing lead to high costs and low cost-effectiveness when compared with endoscopic techniques. Fecal DNA testing promises to improve the performance characteristics of stool testing. Small trials of multitarget assays demonstrate a sensitivity for colorectal cancer of 62 to 91% and a sensitivity for adenomas of 26 to 73%. The specificity of these assays is high, ranging from 93 to 100%. The major drawback of fecal DNA testing, compared with other fecal colorectal cancer screening tests, is the cost. SUMMARY: Preliminary data on fecal DNA tests show better performance characteristics than fecal occult blood tests. In their current form, however, it is not clear that the added sensitivity merits the additional cost. These tests must be studied in larger cohorts of asymptomatic patients before adequate comparison can be made to established colorectal cancer screening techniques.

Medical student, physician, and public perceptions of health care disparities.

OBJECTIVES: This study investigates first- and fourth-year medical students' perceptions about health care disparities and compares their perceptions with those of physicians and the public. METHODS: We conducted an analysis of a national survey of medical students that included questions addressing unfair treatment of patients in the health care system based on insurance status, money, English language ability, and race/ethnicity. Results were compared with previously collected data from surveys of physicians and the public. The study also analyzed students' opinions about workforce diversity and cultural competence curricula. RESULTS: Medical students were generally more likely than physicians and the public to perceive unfair treatment of patients. First-year medical students were more likely than fourth-year students, and fourth-year students more likely than physicians, to perceive unfair treatment. Minority medical students and physicians were generally more likely than their white counterparts to perceive unfair treatment. The majority of medical students desired more exposure to disparity issues and endorsed medical workforce diversity. CONCLUSIONS: Perceptions of unfair treatment in the health care system differ among medical students, physicians, and the public, as well as among racial/ethnic groups. Minority students and physicians are more likely to perceive greater levels of unfairness. Our results suggest that perceptions of unfair treatment may decline during the process of acculturation to the medical profession. Interventions to reduce health care disparities must address the process of medical education and training.

Vitrectomy as a treatment for elevated intraocular pressure following intravitreal injection of triamcinolone acetonide.

PURPOSE: To report control of intravitreal triamcinolone acetonide-induced elevated intraocular pressure (IOP) by vitrectomy-assisted corticosteroid removal. DESIGN: Interventional case series. METHODS: Of the 26 eyes that had intravitreal injection of triamcinolone acetonide for various causes, 11 eyes (42.5%) developed elevated IOP. In nine eyes IOP was controlled by antiglaucoma medication. Two eyes of two patients developed uncontrolled IOP despite maximal antiglaucoma medication. These eyes underwent vitrectomy and removal of triamcinolone acetonide. RESULTS: IOP returned to normal in 3 weeks and 1 week, respectively, after vitrectomy. CONCLUSIONS: Elevated IOP associated with intravitreal injection of triamcinolone acetonide that is not controlled by maximal antiglaucoma medication can be effectively treated by vitrectomy-assisted removal of triamcinolone acetonide.

Orbital cysticercosis-associated scleral indentation presenting with pseudo-retinal detachment.

PURPOSE: To report a clinical picture similar to retinal detachment caused by orbital myocysticercosis-associated scleral indentation. DESIGN: Interventional case series. METHODS: Of the 49 cases of orbital myocysticercosis, four eyes of four patients had pseudoretinal detachment presentations that are detailed. RESULTS: Of the four patients with pseudoretinal detachment, three were found to have orbital myocysticerci in lateral and one in inferior recti muscles, mechanically indenting the eyeball, causing scleral indentation, evidenced by ultrasonography or computed tomography. Associated signs of myocysticercosis were orbital inflammation, restricted ocular motility or proptosis. In 2 to 10 days, the cysts traveled forward and came to lie in a sub-Tenon position. Three cysts were removed surgically and one extruded spontaneously. CONCLUSIONS: Patients presenting with a clinical picture similar to retinal detachment in the presence of symptoms and signs of orbital cysticercosis, with a history of exposure to an endemic area, should be considered to have orbital myocysticerci causing scleral indentation.

Conjunctival ulceration following triamcinolone injection.

PURPOSE: To report conjunctival ulceration as a complication of periocular triamcinolone acetonide injection. Interventional case series. METHODS: Conjunctival ulceration was found in three patients who had anterior subtenon's or subconjunctival deposition of triamcinolone. Cultures from the ulcer edges were negative. RESULTS: Most of the triamcinolone extruded, and the conjunctival ulcers healed with minimal scarring. CONCLUSIONS: Conjunctival ulceration was a potential complication of periocular triamcinolone injection in three patients who had anterior subtenon's or subconjunctival deposition of the corticosteroid.