National oral health survey on refugees in Germany 2016/2017: caries and subsequent complications.

OBJECTIVES: To assess oral health, caries prevalence, and subsequent complications among recently arrived refugees in Germany and to compare these findings with the German resident population. METHODS: This multicenter cross-sectional study recruited 544 refugees aged 3-75+ years; they were examined at ten registration institutions in four federal states in Germany by two calibrated dentists. The refugees were screened for caries (dmft/DMFT) and its complications (pufa/PUFA); this data was compared to the resident population via the representative national oral health surveys). RESULTS: The deciduous dentition of the 3-year-old refugees had a mean dmft value of 2.62 ± 3.6 compared with 0.48 dmft in the German resident population, and caries increased to 5.22 ± 3.4 for 6-7-year-olds (Germany: 1.73 dmft). Few refugee children had naturally healthy teeth (7% in 6-7-year-olds, Germany: 56%). In the permanent dentition, the gap in caries prevalence between refugees and the German population decreased with age (35-44-year-olds: 10.55 ± 7.1 DMFT; Germany: 11.2), but refugees exhibited more caries defects (35-44-year-olds DT = 3.13 ± 3.0; Germany: 0.5). German residents had more restorations (35-44-year-olds FT = 4.21 ± 4.6). Regarding complications, the 6-7-year-olds exhibited the highest pufa index (0.86 ± 1.4) which decreased in adolescence (13-17-year-olds, 0.18 ± 0.6) and increased in adults (45-64-year-olds, 0.45 ± 0.8). CONCLUSION: The refugees had high caries experience, often untreated caries teeth and more complications compared with the German resident population, especially in children. Closing this gap by extending preventive systems to the refugees would decrease future treatment needs. CLINICAL RELEVANCE: European countries should be prepared for the higher dental treatment needs in recent refugees, especially in children.

Unravelling the utility of modern sulfonylureas from cardiovascular outcome trials and landmark trials: expert opinion from an international panel.

AIM: The primary objective of this review is to develop practice-based expert group opinions on the cardiovascular (CV) safety and utility of modern sulfonylureas (SUs) in cardiovascular outcome trials (CVOTs). BACKGROUND: The United States Food and Drug Administration issued new guidance to the pharmaceutical industry in 2008 regarding the development of new antihyperglycemic drugs. The guidance expanded the scope for the approval of novel antihyperglycemic drugs by mandating CVOTs for safety. A few long-term CVOTs on dipeptidyl peptidase 4 inhibitors, glucagon-like peptide 1 receptor agonists, and sodium-glucose cotransporter 2 inhibitors have been completed, while others are ongoing. SUs, which constitute one of the key antihyperglycemic agents used for the management of type 2 diabetes mellitus (T2DM), have been used as comparator agents in several CVOTs. However, the need for CVOTs on modern SUs remains debatable. In this context, a multinational group of endocrinologists convened for a meeting and discussed the need for CVOTs of modern SUs to evaluate their utility in the management of patients with T2DM. At the meeting, CVOTs of modern SUs conducted to date and the hypotheses derived from the results of these trials were discussed. REVIEW RESULTS: The expert group analyzed the key trials emphasizing the CV safety of modern SUs and also reviewed the results of various CVOTs in which modern SUs were used as comparators. Based on literature evidence and individual clinical insights, the expert group opined that modern SUs are cardiosafe and that since they have been used as comparators in other CVOTs, CVOTs of SUs are not required. CONCLUSION: Modern SUs can be considered a cardiosafe option for the management of patients with diabetes mellitus and CV disease; thus CVOTs among individuals with T2DM are not required.

Fixed-dose combination in management of type 2 diabetes mellitus: Expert opinion from an international panel.

Type 2 diabetes mellitus (T2DM) is a progressive disease with multifactorial etiology. The first-line therapy includes monotherapy (with metformin), which often fails to provide effective glycemic control, necessitating the addition of add-on therapy. In this regard, multiple single-dose agents formulated as a single-dose form called fixed-dose combinations (FDCs) have been evaluated for their safety, efficacy, and tolerability. The primary objective of this review is to develop practice-based expert group opinion on the current status and the causes of concern regarding the irrational use of FDCs, in Indian settings. After due discussions, the expert group analyzed the results from several clinical evidence in which various fixed combinations were used in T2DM management. The panel opined that FDCs (double or triple) improve patient adherence, reduce cost, and provide effective glycemic control and, thereby, play an important role in the management of T2DM. The expert group strongly recommended that the irrational metformin FDC's, banned by Indian government, should be stopped and could be achieved through active participation from the government, regulatory bodies, and health ministry, and through continuous education of primary care physicians and pharmacists. In T2DM management, FDCs play a crucial role in achieving glycemic targets effectively. However, understanding the difference between rational and irrational FDC combinations is necessary from the safety, efficacy, and tolerability perspective. In this regard, primary care physicians will have to use a multistep approach so that they can take informed decisions.

Maternal Smoking during Pregnancy Is Associated with Offspring Hypodontia.

Little is known about environmental risk factors for hypodontia. The objective of this study was to investigate the association between hypodontia and common environmental risk factors, such as maternal smoking and alcohol and caffeine consumption during pregnancy. Eighty-nine hypodontia cases with 1 or more missing permanent lateral incisors and/or 1 or more missing premolars were enrolled in this clinic-based case-control study. Some 253 controls with no missing teeth were frequency matched to cases by age and sex. Hypodontia was diagnosed using panoramic radiographs. Sociodemographic data were collected from both the participants and their mothers, with maternal self-reported active and passive smoking, as well as alcohol and caffeine consumption during pregnancy, assessed by a questionnaire. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated with logistic regression to assess the strength of association between risk factors and hypodontia. OR estimates were then adjusted for possible confounders, such as maternal age at delivery, sex and gestational age of the child, and household socioeconomic background. Significant associations were found between hypodontia and maternal cigarette use during pregnancy, as well as the number of cigarettes smoked per day. The consumption of 10 or more cigarettes per day during pregnancy was associated with greater odds of having a child with hypodontia (adjusted OR, 4.18; 95% CI, 1.48-11.80; P = 0.007). Observed associations between hypodontia, second-hand smoke, and alcohol and caffeine consumption were not statistically significant. Maternal smoking during pregnancy is associated with hypodontia. Larger samples and prospective observational study designs, however, are needed to investigate this association further.

Impact of providing patients with copies of their medical correspondence: a randomised controlled study.

BACKGROUND: In Australia, correspondence is routinely sent to general practitioners following a specialist consultation. Written communication is an important way to enhance patient experiences and understanding, yet most patients do not receive copies of their medical correspondence. AIMS: To determine whether providing clinic correspondence and endoscopy reports to patients leads to improved understanding, satisfaction or anxiety. METHODS: This is a prospective, randomised controlled study conducted at an Australian tertiary hospital from October 2013 to February 2015. New adult referrals to the general gastroenterology clinic requiring an urgent endoscopic procedure were eligible for the study. The intervention group received a copy of their clinic correspondence and endoscopy report, while the control group received neither. Participants completed questionnaires, including visual analogue scales and the Hospital Anxiety and Depression Scale, at three time points. Primary outcomes were patient understanding, anxiety and satisfaction. RESULTS: A total of 70 participants was included in the study. There was no reduction in anxiety levels (P = 0.52), no increase in understanding (P = 0.73) or any increase in satisfaction (P = 0.33) in participants receiving correspondence. However, 97% of participants indicated that they wished to receive correspondence in the future, and 94% of participants in the correspondence group reported that receiving correspondence had helped them to understand their medical condition. CONCLUSION: Patients wish to receive copies of their correspondence and feel it improves their understanding of their medical condition. Although we were unable to demonstrate a measurable reduction in anxiety, increase in understanding or satisfaction, we recommend that patients be offered the choice of receiving copies of their clinic correspondence and endoscopy reports.

Noise levels in dental school clinics.

UNLABELLED: Prolonged exposure to noise is a little-investigated occupational hazard in dentistry. There is anecdotal evidence suggesting that noise levels in four student clinics at the School of Dentistry are higher than the current occupational noise level guidelines in New Zealand, Australia and the United Kingdom, which suggest that levels should not exceed 85 dB (A) over a duration of 8 hours. The objectives of this study were to (1) measure the noise levels in the student clinics, and (2) determine whether they exceed current guidelines for occupational noise levels. METHOD: A noise level meter was used to measure the decibel recordings in dB (A), before and during clinical sessions. The types of procedures being carried out by the students were recorded. RESULTS: 127 background recordings and 126 activity recordings were made, with measured noise levels ranging from 50.2 to 77.6 dB (A) for background levels, and 51.4 to 98.0 dB (A) during activity, with means of 60.8 and 70.5 dB (A) respectively. Measurements made in one clinic (the 4SW clinic) were significantly higher than those made in the other clinics (P < 0.001), and one (clinic 2N) gave the lowest readings. CONCLUSION: Noise levels recorded from the clinics at the Otago School of Dentistry exceed those specified in the current New Zealand Occupational Health and Safety guidelines, but they are intermittent rather than continuous.

Child physical abuse: assessment of dental students' attitudes and knowledge in United Arab Emirates.

AIM: To investigate dental students' educational experience, attitudes and knowledge with regard to child physical abuse in all dental schools in United Arab Emirates. METHODS: The data were collected by self-administered structured questionnaire completed by 578 under graduate dental students in four (all) dental schools in United Arab Emirates. Data were analysed using descriptive analyses for responses to each question. RESULTS: The results indicated that there was lack of knowledge of reporting procedure, signs of physical abuse and social indicators among all respondents. Over 80 % of the students agreed that dentists should be legally mandated to report abuse cases and a high percentage (94.3 %) of the participants believed they had an ethical duty to report child abuse. Most students indicated that their dental school was the main source of information on this topic. The majority of the respondents expressed a need for further training. CONCLUSIONS: Dental students were not sufficiently prepared to know what to look for when they suspect child abuse and what to actually do when they encounter this problem in a professional setting. To provide better care for these young domestic violence victims, dental schools' curriculum modifications should focus on providing students with concrete educational experiences regarding child abuse cases.

Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture--a 2 year follow-up study.

INTRODUCTION: Diabetes mellitus confers an increased risk of hip fractures. There is a limited knowledge of how the outcome after a hip fracture in patients with diabetes affect Health Related Quality of Life (HRQoL). The primary aim of this study was to evaluate HRQoL. Secondary aims were reoperation rate, complications and functions in patients with diabetes followed for 2 years after a hip fracture. MATERIALS AND METHODS: Out of 2133 patients diabetes was present in 234 patients (11%). Main outcome measurements were HRQoL evaluated with EuroQoL 5-Dindex score, reoperation rate, surgical and medical complications, function as walking ability, daily activities, living condition and pain. RESULTS: Preoperatively, patients with diabetes mellitus had more pain (p=0.044), co-morbidities, reduced health status (p=0.001) and more often used a walking frame (p=0.014) than patients without diabetes, whereas Katz ADL index, cognition and body mass index did not differ. There was no difference in fracture type, surgical method or reoperation between the two groups or between patients with insulin treated or oral treated diabetes. The EQ-5Dindex score decreased from 0.64 at admission to 0.45 at 4 months, 0.49 at 12 months and 0.51 at 24 months with similar results for patients with and without diabetes. During the first postoperative year there was not more medical complications among patients with diabetes, however cardiac (p=0.023) and renal failure (p=0.032) were more frequent in patients with diabetes at 24 months. Patients with diabetes more often had severe hip pain at 4 months (p=0.031). At 12 months more diabetic patients were living independently (p=0.034). There was no difference in walking ability, ADL and living condition between the groups at 24 months. CONCLUSION: The findings of this study indicate that patients with diabetes mellitus had more pain, co-morbidities, reduced health status preoperatively than patients without diabetes. Hip fracture patients with diabetes mellitus have more hip pain at 4 months. Cardiac and renal failure was more frequent in patients with diabetes at 24 months but otherwise we found a comparable re-operation rate, function and deterioration of Health Related Quality of Life as patients without diabetes within 2 years after a hip fracture.

An eye on sexually transmitted diseases: sexually transmitted diseases and their ocular manifestations.

Ocular examination should be a part of the routine assessment of the patients seen at sexually transmitted diseases (STD) clinics due to the importance of these organs in the general wellbeing of patients. It is essential to keep an open eye on ocular signs and symptoms of patients with a history of exposure to common STD pathogens, to ensure prompt investigation and management of ocular complications of the STDs, which, if left unnoticed, otherwise could subject the patients to a great deal of anxiety and distress.

What you can see in your patient's eyes? Review of ocular manifestations of HIV in HAART era.

The early diagnosis and treatment of ocular disease to prevent morbidity and mortality of patients with human immunodeficiency virus (HIV) is of paramount importance. Since the advent of highly active antiretroviral therapy (HAART), the incidence of ocular complications of HIV has decreased and their manifestations and natural course are also modified. This has been observed in the face of emerging immune recovery, which per se has brought new difficulties in the process of diagnosing and management of the ocular disease. Conditions such as immune recovery uveitis could affect eyes with history of opportunistic disease with a potential to cause vision loss; with this regard, differentiation of the inflammatory process from infective causes is essential. The other sexually contracted diseases are also to be included in this complex picture because of their contribution to the clinical picture and also sharing common routes of transmission with HIV. There is very little doubt that visual deterioration would further deteriorate the already compromised quality of life of this group of patients. In this review, authors wish to provide evidence available in the medical literature around the visual health issues in HIV-infected patients and raise awareness towards the changing pattern of the ocular disease in the HAART era.

Guillain-Barre syndrome occurring after adjuvant chemo-radiotherapy for endometrial cancer.

BACKGROUND: The association between Guillain-Barre syndrome (GBS) and malignancy is uncommon and has not been previously reported in gynecological cancers. CASE: Our case documents this syndrome occurring in a patient shortly after completion of adjuvant chemo-radiotherapy for endometrial carcinoma. We review the current literature and discuss potential pathogenic mechanisms of this likely paraneoplastic association. CONCLUSION: GBS in cancer patients is a potentially life-threatening condition and should be differentiated from simple chemotherapy toxicity, particularly as effective treatment is available.

Calcium/calmodulin regulation of the proliferation of human epidermal keratinocytes, dermal fibroblasts and mouse B16 melanoma cells in culture.

We have investigated the relationship between extracellular calcium, intracellular calmodulin and proliferation in normal keratinocytes. Keratinocyte proliferation and its sensitivity to calmodulin antagonists was compared with that of normal human dermal fibroblasts and neoplastic mouse B16 melanoma cells. Keratinocytes were similar to fibroblasts in showing reduced proliferation in low (0.15 mM) calcium medium and unlike B16 cells which continued to proliferate until calcium was reduced to submicromolar levels. Intracellular calmodulin was significantly higher in rapidly dividing keratinocytes in normal (1.15 mM) calcium medium than in slower dividing cells in low (0.15 mM) calcium. Fibroblasts and B16 cells maintained similar calmodulin levels in both low and normal calcium media. Calmodulin antagonists inhibited proliferation of all three cell types equally. Thus, keratinocyte calmodulin seems related to the proliferative state of the cell (unlike fibroblast calmodulin) and calmodulin antagonists may be of use in controlling the hyperproliferation of the psoriatic epidermis.

Germination, respiration, and adenylate energy charge of seeds at various oxygen partial pressures.

The effect of O(2) partial pressure on the germination and the respiration of 12 cultivated species was studied. The reciprocal of the time necessary to observe rootlet emergence in 50% of the seeds was used to approach the germination rate. The maximum germination and respiration rates were reached in most seeds at O(2) pressures close to that of air. Decreasing the O(2) pressure produced a gradual decrease of the germination rate. The seeds could be classed in two groups according to their response to low O(2) pressures. Group I includes lettuce, sunflower, radish, turnip, cabbage, flax, and soybean: at O(2) pressures close to 2 kilopascals, the germination in this group was stopped and the adenylate energy charge was lower than 0.6. Group II includes rice, wheat, maize, sorghum, and pea. The germination rate of these seeds was also gradually decreased by lowering the O(2) partial pressure but germination still occured, very slowly, at 0.1 kilopascal; the adenylate energy charge remained higher than 0.6. These differences in the germination rates and adenylate energy charge values could not be explained by differences in the sensitivity of respiration to O(2).

ATP Production by Respiration and Fermentation, and Energy Charge during Aerobiosis and Anaerobiosis in Twelve Fatty and Starchy Germinating Seeds.

The respiration and fermentation rates were compared in germinating seeds of 12 different cultivated species from five families. In air, fermentation contributes significantly to the energy metabolism only in some species (pea, maize), but is generally negligible when compared to respiration. The fermentation rate under anoxia was related either to the metabolic activity under air or to the adenine nucleotide content of the seeds: it was generally higher in seeds which contain starchy reserves (rice, maize, sorghum, pea), than in seeds which do not contain starch (lettuce, sunflower, radish, turnip, cabbage, flax); however, it was similar in wheat, sorghum (starchy seeds), and soya (nonstarchy seeds). The value of the energy charge of all the seeds was lower under anoxia than in air: after 24 hours under anoxia, it was higher than 0.5 in the starchy seeds and in soya and it was around 0.25 in the other fatty seeds.

Sequential fluoroimmunoassay for measurement of pregnancy specific beta 1 glycoprotein using antibody coupled to magnetisable particles.

A direct, sequential fluoroimmunoassay has been developed for the determination of serum levels of pregnancy specific beta 1 glycoprotein (SP1). The method employs rabbit anti-SP1 serum coupled to magnetisable cellulose-iron oxide particles and fluorescein-labelled SP1. Serum samples or standards are incubated with magnetisable solid phase anti-SP1 for 30 min. After magnetic sedimentation of the particles, the supernate, which includes endogenous fluorophores and other interfering factors, is discarded. Fluorescein-labelled SP1 is then added and incubated for a further 45 min; the particles are again sedimented and the fluorescence of the labelled SP1 remaining in the supernate is estimated. This reading related directly to the SP1 content of the original sample. The entire procedure, including fluorometry, is performed within a single disposable polystyrene test tube and is sufficiently simple and reliable for routine application. The sensitivity, specificity and precision is very similar to that of radioimmunoassay, and the results correlate with those of the radioimmunoassay (r = 0.9887).

Measurement of placental protein 5, placental lactogen and pregnancy-specific beta 1 glycoprotein in mid-trimester as a predictor of outcome of pregnancy.

The circulating levels of placental protein 5 (PP5), placental lactogen (hPL) and pregnancy-specific beta 1-glycoprotein (SP1) were measured in 254 women at the 16th week of pregnancy and the levels were correlated to fetal outcome in late pregnancy. A significant association was shown between high PP5 levels and premature delivery, and low SP1 levels and intrauterine growth retardation. Measurement of placental proteins in the first half of pregnancy may be a valuable clinical index of fetal outcome in late pregnancy.

Circulating concentrations of specific placental proteins (human chorionic gonadotropin, pregnancy-specific beta-1 glycoprotein, and placental protein 5) in untreated gestational trophoblastic tumors.

Serum levels of human chorionic gonadotropin (hCG), pregnancy-specific beta-1-glycoprotein (SP1), and placental protein 5 (PP5) were measured prior to treatment in 14 patient with hydatidiform mole and in nine patients with choriocarcinoma. Measurement of circulating levels of SP1 and PP5, but not hCG, provides a distinction between benign and malignant gestational trophoblastic tumors.