Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring.

To compare electronically monitored (MEMS) with self-reported adherence in drug users, including the impact of adherence on HIV load, we conducted a 6-month observational study of 67 antiretroviral-experienced current and former drug users. Adherence (percentage of doses taken as prescribed) was calculated for both the day and the week preceding each of 6 research visits. Mean self-reported 1-day adherence was 79% (median, 86%), and mean self-reported 1-week adherence was 78% (median, 85%). Mean MEMS 1-day adherence was 57% (median, 52%), and mean MEMS 1-week adherence was 53% (median, 49%). One-day and 1-week estimates were highly correlated (r>.8 for both measures). Both self-reported and MEMS adherence were correlated with concurrent HIV load (r=.43-.60), but the likelihood of achieving virologic suppression was greater if MEMS adherence was high than if self-reported adherence was high. We conclude that self-reported adherence is higher than MEMS adherence, but a strong relationship exists between both measures and virus load. However, electronic monitoring is more sensitive than self-report for the detection of nonadherence and should be used in adherence intervention studies.

Esthetic facial surgery for women.

Women of all ages are increasingly seeking facial cosmetic surgery for personal and professional reasons. A wide array of surgical procedures is available to address each woman's specific request. Esthetic facial surgery and cosmetic dentistry may complement each other to provide dramatic results.

Pilot study of expedited HIV-1 testing of women in labor at an inner-city hospital in New York City.

To evaluate the feasibility of offering voluntary counseling and expedited human immunodeficiency virus (HIV) testing to women in labor, and to assess the characteristics of two rapid HIV assays compared with results from an expedited standard enzyme immunoassay (EIA), with Western blot confirmation, as indicated, we undertook a pilot study immediately prior to enactment of New York State regulations (August 1999) requiring expedited testing of laboring women (or newborns) with undocumented HIV status. From June 9, 1999 through July 2, 1999, we offered HIV counseling and testing (C&T) to all medically stable women in active labor, 106 of 125 (85%) of whom accepted. One woman was confirmed HIV-1 seropositive. Rapid assay sensitivity and specificity were: SUDS 100 and 98%, and Multispot 100 and 100%, respectively in comparison with 100 and 99% for the standard EIA. The positive predictive values (PPV) were SUDS 33%; Multispot 100%; and EIA 50%. While our sample size was small, it appears that the accuracy of rapid and expedited HIV assays may be improved by requiring two different reactive assays before informing women of HIV-seropositive results or initiating antiretroviral treatment.

Topical antibiotic prophylaxis for bacteremia after dental extractions.

OBJECTIVE: Current prophylaxis for endocarditis in patients undergoing dental procedures consists of oral administration of amoxicillin. There is concern that the risk of anaphylaxis from systemically administered antibiotics might approach the incidence of endocarditis. Emergence of resistance among bacteria is also favored by systemically administered antibiotics. The present study was designed to assess the efficacy of topical amoxicillin given prophylactically as a mouthwash in reducing the incidence of bacteremia after dental extraction. STUDY DESIGN: Thirty-six outpatients in a dental clinic were randomized in a 3:2:2 ratio to experimental prophylaxis of topical amoxicillin (3 g per mouthwash rinse; 15 patients), standard prophylaxis of oral amoxicillin (3 g in a single dose; 11 patients), or no prophylaxis (10 patients), respectively. Patients were stratified by severity of periodontal disease and number of teeth extracted. Data were analyzed for differences in the incidence of bacteremia by means of the 2-tailed Fisher exact test. RESULTS: Breakthrough bacteremia after dental extraction was observed in 60% (6 of 10 patients) who received topical amoxicillin and in 89% (8 of 9 patients) who received no prophylaxis (P =.30). By comparison, breakthrough bacteremia after dental extraction was observed in 10% (1 of 10 patients) who received standard prophylaxis with oral amoxicillin (60% vs 10%; P =.05). CONCLUSIONS: Topical amoxicillin decreased the incidence of bacteremia in comparison with no prophylaxis, but statistical significance was not achieved (P =.30). Topical amoxicillin was significantly less effective than standard prophylaxis with oral amoxicillin in decreasing the incidence of bacteremia after dental extractions.

Surgical management of sports-related traumatic injuries.

The increasing popularity of all sporting events results in increased potential for injury. Despite helmet, facemask, and mouthguard use, the face often remains an exposed area at risk in many sports. Dentists rehabilitating patients after facial injuries should understand their patients' previous injuries and treatment.

Hepatitis: implications for dental care.

Patients with hepatitis and liver dysfunction present an array of pathophysiologic alterations for the practitioner to evaluate. An understanding of how treatment may be affected by liver disease is essential before dental treatment is begun.

Diagnosis and treatment of postoperative complications after skin resurfacing.

Chemical peel, dermabrasion, and laser skin resurfacing are alternative methods to achieve skin resurfacing for reconstructive or cosmetic applications. The potential postoperative complications are similar with all of these techniques. These postoperative complications and their therapy are reviewed.

Pharmacology of agents used in the management of patients having skin resurfacing.

Many medications are used in the preparation, operative, and postoperative phases of skin resurfacing. This article reviews those medications that impact on laser, chemical peel, and dermabrasion surgery. Facial cosmetic surgeons must fully appreciate the "chemistry" of skin resurfacing.

Stress, coping, and attitudes toward HIV treatment in injecting drug users: a qualitative study.

An exploratory study was conducted with 27 injecting drug users (IDUs) on psychosocial factors (stress, coping reactions, and attitudes toward HIV illness and treatment) which are relevant to treatment acceptance and adherence. A semi-structured interview was used to collect qualitative data in a sample of 13 seropositive and 14 seronegative subjects. The results indicated a range of HIV-specific stressors such as social stigma, uncertainty about the future, disclosure of seropositive status, and monitoring of HIV illness. Seeking of social support, relapse to substance abuse, and mental disengagement were the most common coping reactions reported by the sample; there was a lack of behavioral, problem-focused responses. The study also provided descriptive information on attitudes toward HIV treatment, including fatalism, optimism (hope and control), and ambivalence regarding treatment efficacy. Clinical implications and suggestions for future research are discussed.

Pediatric facial injuries associated with all-terrain vehicles.

All-terrain vehicles (ATVs) are becoming increasingly popular recreational devices. Multiple injuries have been associated with ATV accidents. This report reviews pediatric injuries treated at a regional pediatric trauma center, with special attention to facial trauma, as well as the ATV injury data for the United States.

Management of the oral and maxillofacial surgery patient with end-stage renal disease.

Chronic renal failure (CRF) is the consequence of a multitude of diseases that cause permanent destruction of the nephron. Concurrent with renal failure are a host of changes affecting the homeostatic functioning of the individual. This report outlines the pathophysiology of CRF and highlights its effects on surgical manipulation of the oral and maxillofacial region in this patient population. In addition, some of the common physical findings and alterations in blood chemistries frequently observed in these patients are discussed.

Facial-skeletal manifestations of Engelmann's disease.

Engelmann's disease is a hereditary bone disorder that affects the axial and the appendicular skeleton. The facial examination is altered secondary to the progressive osseous changes. This report presents a case of Engelmann's disease in a patient with maxillofacial trauma and reviews the associated facial and skeletal manifestations.

Patient perceptions of diabetes treatment goals.

The current treatment of type II noninsulin dependent diabetes mellitus (NIDDM) and obesity involves complex regimens for weight reduction and improvement in metabolic control that necessitate active participation by the patient in establishing treatment goals and strategies. However, well-documented rates of nonadherence suggest that weaknesses may exist in patient-provider communications that preclude such patient participation. This study examines patient perceptions of diabetes treatment goals as established with their health care providers. Fifty-four individuals with type II NIDDM and obesity were surveyed. To determine the degree of congruence between patient and health care provider, the physicians of study participants were also surveyed. A 53% discrepancy rate was found to exist in the area of overall treatment goals. In addition, a 57% and 43% rate of discrepancy was found for the specific goals of weight loss and blood glucose levels, respectively. Further findings and the implications for practice are discussed in this paper.

Incidence of nasolacrimal injury and turbinectomy--associated atrophic rhinitis with Le Fort I osteotomies.

Injury to the lacrimal system can occur with trauma, craniofacial surgery, rhinoplasty and nasal antrostomy. Nasolacrimal duct injury may potentially occur with Le Fort I superior repositioning. Atrophic rhinitis is also a potential complication secondary to turbinectomy required during Le Fort I superior repositioning. A review of thirty-four cases over three years of Le Fort I osteotomies with superior repositioning found no postoperative lacrimal injury and no subsequent atrophic rhinitis associated with turbinectomy. An anatomical study relating the position of the nasolacrimal duct opening within the inferior meatus and the distance available for maxillary impaction is reviewed.

Transmaxillary temporalis transfer for reconstruction of a large palatal defect: report of a case.

The infratemporal transmaxillary transfer of a temporalis myofascial flap for reconstruction of an extensive palatal defect in an adult cleft palate patient is described. A modified temporal approach is discussed.

Closure of alveolar clefts with corticocancellous block grafts and marrow: a retrospective study.

A surgical technique is presented for maxillary alveolar cleft repair that includes a contoured iliac crest corticocancellous block graft and marrow packing, along with closure by a Y-vestibular mucosal advancement flap. A retrospective study of graft survival in 48 cleft sites showed a 94% success rate with no complications; the remaining 6% of the cases showed minor complications.