Clinical and microbiological evaluation of 940-nm diode laser as an adjunct to modified Widman flap for the management of chronic periodontitis: A 6-month randomized split-mouth clinical trial.

Background. The present randomized clinical trial aimed to determine the additive clinical and microbiological benefits of diode laser (DL) with modified Widman flap (MWF) to manage chronic periodontitis. Methods. Seventy-two sites in 36 healthy non-smoking patients diagnosed with chronic periodontitis were randomly assigned to the test group (MWF + active DL) or control group (MWF + sham DL). Clinical (probing pocket depth [PPD], clinical attachment level [CAL]) and microbiological (colony-forming units [CFUs]) measurements were recorded at baseline and 6- and 6-month postoperative intervals. Results. Compared to baseline, 6-month results showed significant changes in clinical and microbiological parameters in both groups. However, the intergroup comparison revealed significantly lower PPD (1.90±0.48 mm vs. 2.35±0.41 mm), CAL (4.43±0.57 mm vs. 4.93±0.58 mm), and CFUs for Porphyromonas gingivalis (6.32±0.18 vs. 8.88 ±1.88), Prevotella intermedia (7.62±1.86 vs. 8.12±1.78), and Aggregatibacter actinomycetemcomitans (6.43±1.44 vs. 7.24±1.22) in the test group after six months. Conclusion. Within the limitations, the present study confirmed the useful role of DL with MWF to manage chronic periodontitis.

Predictable Treatment of Gingival Recession Using Titanium Prepared Platelet-Rich Fibrin in Combination with Coronally Advanced Flap.

Treatment for receding gums is always a challenging task for a periodontist. To fulfill this, many surgical techniques such as free gingival grafts, connective tissue grafts, pedicle flaps, and lateral sliding flaps have been used. For better prevention of relapse of these procedures and to improve the gingival biotype, various biomaterials such as platelet-rich fibrin, collagen matrix, and amnion chorion membranes have been additionally utilized. Due to advancements in preparation of platelet concentrates titanium platelet-rich fibrin, a third-generation platelet concentrate was introduced. Unlike other biomaterials, it has thicker fibrin meshwork with greater cellular entrapment and thicker membrane. Present case reports depict the usage of titanium platelet-rich fibrin as a biomaterial along with coronally advanced flap in the treatment of millers Class-I gingival recessions. Patients were followed up to 6 months after performing recession coverage treatments.

Distress evaluation in a veteran affairs oncology clinic.

Distress in oncology patients (pts) has a negative impact on quality of life, survival, and healthcare satisfaction. Higher distress leads to lower compliance with treatment and follow-up [1-8]. The 2012 American College of Surgeons Commission on Cancer (CoC) standard of care for oncology pts included an assessment for distress [1]. A screening process for distress allows the healthcare team to address these issues early and refer to appropriate resources [2-9]. This project was initiated to meet National Comprehensive Cancer Network (NCCN) and CoC standard of care, identify distress in veterans with cancer, and address these concerns. Patients who attended the Tuesday oncology clinic at the Dayton VAMC were given the NCCN Distress Thermometer (DT) during triage. The treating physician addressed problems identified. The Wilcoxon signed rank test and the Friedman test were used. DTs were completed by 296 pts from March to December 2016. Mean age was 68, 93% male, 83% white, 55% married, and 93% without PTSD. The distress level was not different from T1 through T3. Number of problems decreased over three time periods. Referrals to nutrition, mental health, and social work services increased over time. Although over time periods we found no decrease in distress scores, there was a decline in number of problems. The mean distress score at all but time 4 was < 4, which is considered mild distress. The mean distress score at T4 was 4.36 (n = 14), suggesting that the few pts who return to clinic more than three times may be experiencing more difficult personal and environmental circumstances. Patient sample ranged from those undergoing intensive cancer treatment (e.g., chemotherapy) to less intensive treatment (e.g., hormone injections) to those who completed treatment.

Soluble CD163 as a biomarker of periodontal disease - A biochemical study using enzyme-linked immunosorbent assay.

BACKGROUND: The aim of the study was to evaluate the levels of soluble CD163 (sCD163) in gingival crevicular fluid (GCF) and blood serum of individuals having periodontitis, gingivitis, and healthy periodontium. Further, the role of sCD163 as a biomarker of periodontal disease was also assessed. MATERIALS AND METHODS: A minimum of 5-µl GCF and 10 ml of venous blood was collected using a micropipette and 10-ml syringe, respectively, from the study population which was divided into three groups as healthy (Group I, n = 10), gingivitis (Group II, n = 10), and periodontitis (Group III, n = 10). sCD163 samples were assessed using a commercially available sCD163 enzyme-linked immunosorbent assay kit. Clinical parameters such as oral hygiene index simplified, gingival index (GI), percentage of sites with bleeding on probing, probing depth, and clinical attachment loss were recorded. RESULTS: The mean serum sCD13 levels were 743.45 ± 51.17 ng/ml, 563.25 ± 103.74 ng/ml, and 431.0 ± 31.08 ng/ml when compared to the mean GCF sCD163 levels which were 59.81 ± 7.61 ng/ml, 38.93 ± 12.42 ng/ml, and 30.49 ± 12.60 ng/ml for periodontitis, gingivitis, and healthy individuals, respectively. The sCD163 levels were higher in patients with periodontitis when compared to the periodontally healthy individuals. CONCLUSION: Within the limitations of the present study, it can be concluded that sCD163 levels can be used as a diagnostic marker of disease as its levels are remarkably increased in GCFs of patients having periodontitis.

Pinhole Surgical Technique - A Novel Minimally Invasive Approach for Treatment of Multiple Gingival Recession Defects: A Case Series.

Gingival recessions are one of the most prevalent periodontal diseases. Hypersensitivity and esthetics are the major concerns associated with recession defects. There are various treatment modalities for its management, but recently, minimally invasive techniques have gained much importance because of lower patient morbidity and comparable results when compared to conventional techniques. This case series represents a 6-month follow-up of a recently introduced pinhole surgical technique where the percentage of root coverage was found to be statistically significant.

A Rare Case of Mucoepidermoid Carcinoma of Parotid with Mandibular Metastasis.

Mucoepidermoid carcinoma is the most common malignant tumor of salivary gland. Majority of the salivary gland tumors arise in parotid gland with maximum being of benign nature. Although Mucoepidermoid carcinoma accounts for less than 10% of all tumors of the salivary gland, it constitutes approximately 30% of all malignant tumors of the salivary gland. It is characterized by a mixed pattern of the two main cell types: epidermoid and mucus-producing cells. Metastasis from salivary gland malignancy is infrequent and predominantly found in bone, lung, liver and lymph nodes. We are presenting a rare case of metastasis of mucoepidermoid carcinoma of parotid gland to the contralateral mandible.

The Influence of Palliative Care Consultation on Health-Care Resource Utilization During the Last 2 Months of Life: Report From an Integrated Palliative Care Program and Review of the Literature.

BACKGROUND: We reviewed 104 consecutive deaths of veterans receiving care in the Dayton VA Medical Center from October 10, 2015 to April 11, 2016. The purpose of our study was to test our hypothesis that palliative care consultation would be associated with reduced health care resource utilization for individuals approaching end of life. METHODS: Medical records were reviewed and data entry recorded on a spreadsheet. Non-parametric statistical methods were used to compare four outcome variables from veterans with palliative care consultation (PCC) vs. those without PCC. These variables included the number of ED visits, hospitalizations, hospital days, and ICU days all during the last two months of life. Predictor variables included PCC vs. no PCC and PCC before vs. PCC during the last two months of life. The study sample was comprised of 102 patients after excluding two outlier cases with ethical challenges in surrogate decision-making. RESULTS: Of the 102 consecutive veteran deaths, palliative care consultation was associated with a lower number of ICU days during the last two months of life. For 96 veterans with PCC, the frequency of ED visits and acute care hospitalizations, as well as the number of ICU and hospital days, were all significantly less after PCC compared to before PCC during the last two months of life. The timing of PCC had no effect on the outcomes of interest. CONCLUSION: Palliative care consultation has a notable effect on health care resource utilization during the last two months of life.

Timeliness of Lung Cancer Diagnosis and Treatment.

Most patients received timely histopathologic confirmation of diagnosis, but surgery candidates faced significant delays in care in this quality improvement analysis.

Graves' disease causing pancytopenia and autoimmune hemolytic anemia at different time intervals: a case report and a review of the literature.

Graves' disease (GD) is associated with various hematologic abnormalities but pancytopenia and autoimmune hemolytic anemia (AIHA) are reported very rarely. Herein, we report a patient with GD who had both of these rare complications at different time intervals, along with a review of the related literature. The patient was a 70-year-old man who, during a hospitalization, was also noted to have pancytopenia and elevated thyroid hormone levels. Complete hematologic workup was unremarkable and his pancytopenia was attributed to hyperthyroidism. He was started on methimazole but unfortunately did not return for followup and stopped methimazole after a few weeks. A year later, he presented with fatigue and weight loss. Labs showed hyperthyroidism and isolated anemia (hemoglobin 7 g/dL). He had positive direct Coombs test and elevated reticulocyte index. He was diagnosed with AIHA and started on glucocorticoids. GD was confirmed with elevated levels of thyroid stimulating immunoglobulins and thyroid uptake and scan. He was treated with methimazole and radioactive iodine ablation. His hemoglobin improved to 10.7 g/dL at discharge without blood transfusion. Graves' disease should be considered in the differential diagnosis of hematologic abnormalities. These abnormalities in the setting of GD generally respond well to antithyroid treatment.

Assessment of hospice patients' goals of care at the end of life.

OBJECTIVE: to evaluate satisfaction with inpatient hospice goals at the end of life and to determine steps for program improvement. STUDY DESIGN AND SETTING: prospective observational study of patients admitted to an inpatient Veterans Affairs Medical Center hospice unit, located in an urban setting with dedicated 16 hospice and 20 palliative care beds. Patients and their families are cared for by an interdisciplinary team. POPULATION: veteran population receiving care in an inpatient hospice unit whose goals are comfort care. INTERVENTION: two anonymous surveys of patient goals were distributed upon admission to hospice unit patients and families, who were asked to complete the first survey within 1 to 5 days of admission and the second survey 2 weeks after admission or later. OUTCOME MEASURE: patient and family centered end-of-life care outcomes, including meeting goals of care with desired symptom management, emotional support to the dying patient, coordinated care, shared decision making, and attending to the emotional needs of families. RESULTS: fifty patients were given surveys between June and September 2009. Response rate was 52% for the first survey and 36% for the second survey. Most important goals for 90% of veterans were control of symptoms and being with family. More than 90% of our patients' families, responding to our second survey, strongly agreed that these goals were achieved. We also identified other needs of hospice veterans, and family surveys showed that these were also accomplished. CONCLUSION: clarification and focus on goals of care improves satisfaction with end-of-life care.

Efficacy of a scheduled IV cocktail of antiemetics for the palliation of nausea and vomiting in a hospice population.

This is a retrospective analysis of 10 mg metoclopramide, 25 mg diphenhydramine, and 4 mg dexamethasone given intravenous piggyback every 6 hours for nausea or vomiting. Outcome measures were rapidity of symptom relief based on the self-report of the patient and nursing documentation of relief from symptoms of nausea or vomiting. Seven hundred and ninety seven patients were admitted to the inpatient hospice unit during a 2-year period. Sixty-three patients developed nausea or vomiting requiring the cocktail. Fifty-seven patients (90%) had objective response as reflected in nursing notes. Symptom relief was usually noted within 2 days with improvement in oral intake and enjoyment in activities, such as parties and family interactions. Partial relief was noted in patients with gastrointestinal malignancies and peritoneal carcinomatosis even with the addition of other antiemetics to the cocktail.

Sweet's syndrome associated with sargramostim (granulocyte-macrophage colony stimulating factor) treatment.

Sweet's syndrome is an acute febrile neutrophilic dermatosis that is a known complication of the administration of filgrastim, a drug that causes increased neutrophil proliferation and differentiation. This complication has not previously been reported during treatment with sargramostim, a hematopoietic cytokine with activity that overlaps filgrastim. We report a case of Sweet's syndrome in association with sargramostim treatment following chemotherapy for acute myelogenous leukemia. A suspected second episode occurred after subsequent chemotherapy and sargramostim treatment. Physicians should be aware of this possible association because the signs and symptoms of Sweet's syndrome are easily mistaken as being due to infection.

A longitudinal study of attitudes toward physician-assisted suicide and euthanasia among patients with noncurable malignancy.

This longitudinal study investigated whether attitudes toward physician-assisted suicide (PAS) and euthanasia (E) are stable among patients with noncurable malignancy, and whether depression and various coping strategies were related to such attitudes. Thirty patients with noncurable malignancies completed questionnaires measuring attitudes toward PAS and E, depression, and coping. Three months later, and subsequently at six-month intervals, repeated measures were obtained from 24 patients. There was a trend for patients to become less supportive of legalizing PAS and E from the initial to last attitude measurement. Depression was unrelated to attitude change. There were significant changes on two coping dimensions: use of social support for emotional reasons and use of religious resources. Our findings should be considered in clinical, legislative, and ethical debates.