The association between nutritional status and frailty characteristics among geriatric outpatients.

BACKGROUND: Frailty is a common clinical syndrome in older adults and is associated with an increased risk of poor health outcomes, e.g. falls, disability, hospitalization, and mortality. Nutritional status might be an important factor contributing to frailty. This study aims to describe the association between nutritional status and characteristics of frailty in patients attending a geriatric outpatient clinic. METHODS: Clinical data was collected of 475 patients who visited the geriatric outpatient department of a Dutch hospital between 2005 and 2010. Frailty was determined by: incontinence, Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Geriatric Depression Scale (GDS) and Mini Mental State Exam (MMSE). Nutritional status was represented by the Mini Nutritional Assessment (MNA) and plasma concentrations of several micronutrients, whereby MNA< 17 indicated malnutrition and MNA 17-23.5 indicated risk of malnutrition. 'More frail' patients (≥3 frailty characteristics) were compared to 'less frail' patients (<3 frailty characteristics) with logistic regression analyses, adjusted for age, sex and other important covariates. RESULTS: Of 404 patients with complete data, mean age (SD) was 80 (7) years and 34% was male. Prevalence of 'more frail' patients was 47%. Prevalence of malnutrition and risk of malnutrition was 16% and 56% respectively. Malnutrition and risk of malnutrition were both independently related to being 'more frail', with ORs (95% CI) of 8.1 [3.5-18.8] and 3.1 [1.7-5.5] respectively. This association was driven by functional decline (ADL, IADL and mobility) and depression (GDS), but not by cognitive impairment (MMSE). None of the micronutrient plasma concentrations were related to frailty. CONCLUSION: In geriatric outpatients, malnutrition is independently related to having ≥3 frailty characteristics. Assessing nutritional status could prove usefulness in early clinical detection and prevention of frailty.

Temporomandibular disorders in patients with rheumatoid arthritis: A clinical study.

OBJECTIVES: The aim of this study is to evaluate the prevalence and type of temporomandibular disorders (TMD) in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: Fifty-four patients having RA treatment at Cukurova University in Rheumatology Clinic were enrolled to the study. Demographic and rheumatologic data were recorded. The patients were examined in Dental Faculty by using Research Diagnostic Criteria/TMD (RDC/TMD) axis I and answered RDC/TMD axis II Biobehavioral Questionnaire. Data were evaluated according instructions for scoring and assessment of RDC/TMD. Mann-Whitney test was performed to compare continuous variables between two groups and Kruskal-Wallis test was performed to compare continuous variables for more than two groups. RESULTS: Although their activity situations were 55.6% active and 44.4% inactive, the distribution of treatment modality was 31.5% for anti-tumor necrosis factor-α (TNF-α) and 68.5% for disease-modifying antirheumatic drugs (DMARD). The distribution of temporomandibular joint (TMJ) involvement was; 9.3% with no involvement, 7.4% with joint involvement, 64.8% with muscular involvement, 18.5% with both muscular and joint involvement. Rheumatologic functional scores were (0) 3.7%, (1) 50%, (2) 38.9%, (3) 7.4%. Patients' chronic pain was graded from 0 to 4 and the distribution was 3.7%, 24.1%, 20.4%, 31.5% and 20.4%, respectively. The mean duration of RA for anti-TNF-α (11.47 ± 7.67) was significantly higher compared with DMARD (7.09 ± 5.21) P = 0.040. CONCLUSION: There was a high prevalence of TMD in RA patients, and muscular involvement was the highest among the TMJ involvements. Thus, this study supports TMJ examination should be encouraged in the rheumatology settings.

Comparative study of the osseous healing process following three different techniques of bone augmentation in the mandible: an experimental study.

The aim of this study was to evaluate the osseointegration of three different bone grafting techniques. Forty-eight mature New Zealand rabbits were divided randomly into three groups of 16 each. Horizontal augmentation was performed on the corpus of the mandible using three different techniques: free bone graft (FBG), free periosteal bone graft (PBG), pedicled bone flap (BF). The animals were sacrificed at postoperative weeks 1, 3, or 8. Specimens were decalcified for histological examination, and histomorphometric measurements were performed. The histological evaluation demonstrated bony fusion between the grafts and the augmented mandibular bone after 8 weeks in all groups. At week 8, the bone volume was significantly greater in the BF group than in the FBG (P<0.001) and PBG (P=0.001) groups, and also the trabecular thickness was significantly greater than in the FBG (P=0.015) and PBG (P=0.015) groups. Trabecular separation was significantly lower in the BF group than in the FBG group at week 8 (P=0.015). BF demonstrated greater osseous healing capacity compared to FBG and PBG. The preserved vascularization in BF improves the bone quality in mandibular bone augmentations.

The effect of systemically administrated zoledronic acid on the osseointegration of dental implants.

OBJECTIVE: The aim of conducting this study was to evaluate the effect of zoledronic acid (ZA) on the new bone formation (NBF) after the insertion of a titanium dental implant, which is very popular treatment in dentistry. STUDY DESIGN: Twelve New Zealand white rabbits were used in this study. The rabbits were divided in two groups. ZA was systemically administered to the study group. Titanium implants were placed to the left and right tibias of the rabbits. RESULTS: The data from the ZA group revealed a statistically significant increase in the bone mineral content and the bone mineral density. A non-decalcified histomorphometric examination conducted on the study group revealed a significant increase of NBF and bone-implant contact (BIC) at 2 and 4 weeks. CONCLUSION: A single dose of systemic ZA administration increases the rate of NBF and augments the quality of the bone.

Sodium iodoacetate induced osteoarthrosis model in rabbit temporomandibular joint: CT and histological study (part I).

Studies to elucidate the pathophysiology of osteoarthrosis have been hampered by the lack of a rapid, reproducible animal model that mimics the histopathology and symptoms associated with the disease. The aim of this study is to evaluate the radiological, histological and histomorphometrical findings of four different concentrations of sodium iodoacetate (MIA) to create osteoarthrosis by using an arthrocentesis technique on rabbit temporomandibular joint (TMJ). 12 New Zealand white male rabbits received an injection of MIA (50 µl dose of 1.5, 2, 2.5, 3mg/ml concentrations) to a single joint of each group by arthrocentesis. Computed tomography (CT) images were obtained pre- and post-injections at 2, 4 and 6 weeks. Early osteoarthritic changes in the rabbit TMJ were found histologically at 4 weeks and with a 3mg/ml concentration of MIA. The mean subchondral bone volume depended on the concentration of MIA and was 62±2.6%, 63±4.1%, 42±3.6% and 38±3.8%, respectively. A minor abnormality was found on CT in six joints at the 4-week follow up. MIA injection and arthrocentesis offer a rapid and minimally invasive method of reproducing histologically osteoarthrotic lesions in the rabbit TMJ.

The effects of high molecular weight hyaluronic acid (Hylan G-F 20) on experimentally induced temporomandibular joint osteoartrosis: part II.

The aim of this study was to determine the efficacy of Hylan G-F 20 on experimentally induced osteoarthritic changes in rabbit temporomandibular joint (TMJ). A 3mg/ml concentration of sodium mono iodoacetate (MIA) had been injected into both joints of 24 rabbits to create osteoartrosis. The study group was injected with Hylan G-F 20 in one joint and saline in the contralateral joint as a control (once a week for 3 weeks). Histological changes in articular cartilage, osteochondral junction, chondrocyte appearance and subchondral bone were determined at 4, 6, and 8 weeks. Regarding cartilage, there was a statistically significant difference between the two groups at 4 weeks. Degenerative bony changes to subchondral bone were significantly higher in the controls. No statistical difference was found in the study group at 6 weeks. A positive correlation was found between osteochondral junction and subchondral bone in the study group at 8 weeks. The changes in chondrocyte appearance were significantly decreased in the study group at all follow-up times. Intra-articular injection of Hylan G-F 20 decreased cartilage changes in early stage TMJ osteoartrosis and clustering of chondrocytes showed the chondroprotective effects of Hylan G-F 20 caused by hypertrophic responses.

Correction of posttraumatic maxillary deficiency by anterolateral alveolar osteotomy.

Anterolateral alveolar osteotomy was performed in a patient who experienced facial trauma in a traffic accident. Bony sequela had remained in the maxilla after the emergency surgery, affecting the facial appearance. A different technique of osteotomy for this unusual type of deformity is presented.