Effectiveness of Gabapentin as a Benzodiazepine-Sparing Agent in Alcohol Withdrawal Syndrome.

Background and Objectives: Gabapentin has shown promise as a potential agent for the treatment of alcohol withdrawal syndrome. We aimed to evaluate the effectiveness of gabapentin as a benzodiazepine-sparing agent in patients undergoing alcohol withdrawal treatment in all the hospitals of a large tertiary healthcare system. Materials and Methods: Medical records of patients admitted to the hospital for alcohol withdrawal management between 1 January 2020 and 31 August 2022 were reviewed. Patients were divided into two cohorts: benzodiazepine-only treatment who received benzodiazepines as the primary pharmacotherapy and gabapentin adjunctive treatment who received gabapentin in addition to benzodiazepines. The outcomes assessed included the total benzodiazepine dosage administered during the treatment and the length of hospital stay. The statistical models were calibrated to account for various factors. Results: A total of 4364 patients were included in the final analysis. Among these, 79 patients (1.8%) received gabapentin in addition to benzodiazepines, and 4285 patients (98.2%) received benzodiazepines only. Patients administered gabapentin required significantly lower average cumulative benzodiazepine dosages, approximately 17.9% less, compared to those not receiving gabapentin (median 2 mg vs. 4 mg of lorazepam equivalent dose (p < 0.01)). However, there were no significant differences in outcomes between the two groups. Conclusions: Our findings demonstrate that using gabapentin with benzodiazepine was associated with a reduction in the cumulative benzodiazepine dosage for alcohol withdrawal. Considering gabapentin as an adjunctive therapy holds promise for patients with comorbidities who could benefit from reducing benzodiazepine dose. This strategy warrants further investigation.

Dermal filler complications: a clinicopathologic study with a spectrum of histologic reaction patterns.

Although dermal fillers are generally accepted as safe and well-tolerable cosmetic tools, adverse reaction still forms a prognostic problem. The aim of this study was to demonstrate the clinicopathologic patterns of dermal filler complications in our center. A 5-year single-center study that included patients complained from filler complications and referred to the dermatopathology unit in Al-Azhar University for histologic assessment. The study included 38 female patients with an average age of 47 years. The mean onset of complications was 14.6 ± 5.27 months after injection. The injected material included hyaluronic acid (18.4%), silicone (52.6%), bovine collagen (15.8%) and polyacrylamide hydrogel (13.2%). Most lesions were located on the face (55.3%), less commonly on the hands (18.4%), buttocks (21%), and rarely on the vulva (5.3%). The clinical spectrum included indurated plaque (23.7%), nodular lesion (31.6%), inflammatory mass (15.8%), atrophic lesion (10.5%), skin discoloration (13.1%) and ulceration (5.3%). Histologically, granulomatous reaction was the major finding, either a foreign body granuloma (34.2%) or infectious granuloma (13.2%). Other histologic reactions included dermal pseudocysts with chronic inflammation (26.3%), dermal fibrosis (15.8%), and eosinophilic panniculitis (10.5%). Our results confirmed that dermal fillers could be manifested with variable clinical presentations and show different histologic reactions. Because of long-standing duration until complications occur, history taking is crucial and should be emphasized in every suspected patient. It is hoped that this article will increase awareness for recognition of these variable complications and help select the appropriate therapy.

The anchorage quality of mini-implants towards translatory and extrusive forces.

AIM: The objective of the present experimental animal study was to investigate the stability of mini-implants (submersion depth 4 mm, Ø 3.3 mm) for orthodontic anchorage. Additionally the histomorphologic effects of orthodontic loading were to be analyzed, especially with regard to the activity and location of periimplant osteodynamic reactions. MATERIAL AND METHOD: 16 titanium implants (Orthosystem, Straumann, Waldenburg, Switzerland) were inserted in edentulous areas of the upper and lower jaw of four foxhounds. After a 6-month healing period the fixtures were loaded with extrusive forces (50 cN) in group 1, and with translatory forces (200 cN) in group 2. The osteodynamic changes during the 6-month force application period were documented using stains with calcium affinity (polychrome sequential labeling). The histologic analysis comprised: microsection method, fluorescence microscopy, toluidine blue staining, histomorphometry. RESULTS: All osseointegrated implants were stable throughout the test period. With respect to the apposition lines, the histomorphometric analysis showed more distinct osteodynamic activity in extrusively loaded than in translatorily loaded implants. The activity was more pronounced in the marginal area than in intermediate and apical implant areas. The extent of peri-implant remodeling activity was up to 980 micro m after extrusive loading and 300-700 microm after translatory loading. CONCLUSIONS: The results suggest that even mini-implants are suited to orthodontic anchorage tasks. The question of the required minimum size of orthodontic anchorage implants remains unanswered.