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OBJECTIVE: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease. METHODS: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation. RESULTS: Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high-resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6-minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs. CONCLUSION: This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.
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OBJECTIVE: We provide evidence-based recommendations regarding screening for interstitial lung disease (ILD) and the monitoring for ILD progression in people with systemic autoimmune rheumatic diseases (SARDs), specifically rheumatoid arthritis, systemic sclerosis, idiopathic inflammatory myopathies, mixed connective tissue disease, and Sjögren disease. METHODS: We developed clinically relevant population, intervention, comparator, and outcomes questions related to screening and monitoring for ILD in patients with SARDs. A systematic literature review was performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A Voting Panel of interdisciplinary clinician experts and patients achieved consensus on the direction and strength of each recommendation. RESULTS: Fifteen recommendations were developed. For screening people with these SARDs at risk for ILD, we conditionally recommend pulmonary function tests (PFTs) and high-resolution computed tomography of the chest (HRCT chest); conditionally recommend against screening with 6-minute walk test distance (6MWD), chest radiography, ambulatory desaturation testing, or bronchoscopy; and strongly recommend against screening with surgical lung biopsy. We conditionally recommend monitoring ILD with PFTs, HRCT chest, and ambulatory desaturation testing and conditionally recommend against monitoring with 6MWD, chest radiography, or bronchoscopy. We provide guidance on ILD risk factors and suggestions on frequency of testing to evaluate for the development of ILD in people with SARDs. CONCLUSION: This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the screening and monitoring of ILD in people with SARDs.
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OBJECTIVE: We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs). METHODS: We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A panel of clinicians and patients reached consensus on the direction and strength of the recommendations. RESULTS: Thirty-five recommendations were generated (including two strong recommendations) for first-line SARD-ILD treatment, treatment of SARD-ILD progression despite first-line ILD therapy, and treatment of rapidly progressive ILD. The strong recommendations were against using glucocorticoids in systemic sclerosis-ILD as a first-line ILD therapy and after ILD progression. Otherwise, glucocorticoids are conditionally recommended for first-line ILD treatment in all other SARDs. CONCLUSION: This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the treatment of ILD in people with SARDs.
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OBJECTIVE: Patient engagement is critical to clinical practice guideline (CPG) development. This work presents our approach to ascertaining patients' values and preferences to inform the American College of Rheumatology guidelines for screening, monitoring, and treatment of interstitial lung disease (ILD) in people with systemic autoimmune rheumatic diseases (SARDs). METHODS: We conducted a cross-sectional qualitative study of a purposefully sampled Patient Panel using a modified content analytic approach. The study team reviewed text transcripts from the Patient Panel discussion to identify themes and develop a clustered thematic schema. RESULTS: Twenty-one patients (75% women) participated, with a mean age of 53 years (range 33-73). Patients had one or more SARDs: systemic sclerosis (38%), Sjögren disease (38%), idiopathic inflammatory myopathy (33%), rheumatoid arthritis (24%), and mixed connective tissue disease (10%). We identified 10 themes in 4 thematic clusters: communication, screening and monitoring, treatment goals, and treatment adverse effects. Patients prioritized recognizing ILD symptoms, importance of ILD screening and close monitoring, goals of survival and improving quality of life, and willingness to accept treatment risks provided that there is close communication with providers. Patient representatives shared patients' priorities and insight at the Voting Panel meeting, influencing multiple guideline recommendations. CONCLUSION: Patient engagement fosters a holistic approach to CPG development, leading to recommendations aiming for the best clinical outcomes while prioritizing outcomes important for patients. The patient-identified themes played a critical role in ILD guideline development and provide core elements for shared decision-making as clinicians make management and therapeutic decisions with patients with SARD-associated ILD.
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OBJECTIVE: We provide evidence-based recommendations regarding the treatment of interstitial lung disease (ILD) in adults with systemic autoimmune rheumatic diseases (SARDs). METHODS: We developed clinically relevant population, intervention, comparator, and outcomes questions. A systematic literature review was then performed, and the available evidence was rated using the Grading of Recommendations, Assessment, Development, and Evaluation methodology. A panel of clinicians and patients reached consensus on the direction and strength of the recommendations. RESULTS: Thirty-five recommendations were generated (including two strong recommendations) for first-line SARD-ILD treatment, treatment of SARD-ILD progression despite first-line ILD therapy, and treatment of rapidly progressive ILD. The strong recommendations were against using glucocorticoids in systemic sclerosis-ILD as a first-line ILD therapy and after ILD progression. Otherwise, glucocorticoids are conditionally recommended for first-line ILD treatment in all other SARDs. CONCLUSION: This clinical practice guideline presents the first recommendations endorsed by the American College of Rheumatology and American College of Chest Physicians for the treatment of ILD in people with SARDs.
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Dental caries is a major public health concern among other oral diseases in most developing and industrialized countries, particularly in those nations where preventative programs have not yet been developed. Adults and the elderly population in Tamil Nadu also face significant challenges related to dental caries beyond children and adolescents. This systematic review examined the comprehensive epidemiology of dental caries in all age groups in Tamil Nadu. The articles were collected using various electronic databases. From the 4509 initially collected articles, 22 articles were chosen for the current umbrella analysis. The collective dental caries prevalence for Tamil Nadu state, India, from 22 studies with 33,584 study participants was 42.8%, with a 95% confidence interval (CI) of 42.3-43.4%. Among the four regions of Tamil Nadu, Eastern Tamil Nadu showed the highest dental caries prevalence of 82.2%. Thus, the strategies by the government of Tamil Nadu should focus on raising awareness about improving oral hygiene practices, seeking access to timely oral healthcare treatments, and strengthening the oral healthcare infrastructure.
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OBJECTIVE: Concerns regarding offering radiotherapy to patients with systemic sclerosis (SSc) stem from the potential worsening of SSc manifestations and radiotherapy toxicity. We conducted a systematic review to evaluate the effects of radiotherapy on SSc outcomes and radiotherapy-related toxicity. METHODS: MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials were searched for SSc and radiotherapy. Inclusion criteria were SSc diagnosis, subsequent cancer development, and radiotherapy exposure. Outcomes were SSc manifestations (cutaneous thickening, pulmonary fibrosis, and SSc flare) and radiotherapy toxicity (acute and late) using Common Terminology Criteria for Adverse Events for grading. Grade 1 and 2 toxicities were categorized as nonsevere and grade 3 to 5 toxicities as severe. RESULTS: Of 121 patients with SSc undergoing radiotherapy (mean age 56.4 years, 83.3% female, median radiotherapy dose 50 Gy), most did not show worsened SSc skin thickening (74.5%) or pulmonary complications (74%) post radiotherapy. In retrospective studies, the average rates of acute adverse effects were 57.3% for nonsevere and 25.8% for severe, whereas the rates of late adverse effects were 32.4% for nonsevere and 24% for severe. CONCLUSION: Although most patients with SSc do not exhibit significant worsening of SSc manifestations post radiotherapy, there is a variable risk of acute and late toxicity. These findings suggest that although radiotherapy may be a viable option for patients with cancer with SSc, it requires caution.
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OBJECTIVE: The aim of our study was to compare dispensation of rheumatic medications between older male and female patients with early rheumatoid arthritis (RA) and psoriatic arthritis (PsA). METHODS: This retrospective cohort study was performed using health administrative data from Ontario, Canada (years 2010-2017), on patients with incident RA and PsA, who were aged ≥ 66 years at the time of diagnosis. Yearly dispensation of rheumatic drugs was compared between older male and female patients for 3 years after diagnosis using multivariable regression models, after adjusting for confounders. The groups of drugs included in the analysis were disease-modifying antirheumatic drugs (DMARDs) classified as conventional synthetic DMARDs (csDMARDs) and advanced therapy (biologic DMARDs and targeted synthetic DMARDs), nonsteroidal antiinflammatory drugs (NSAIDs), opioids, and oral corticosteroids. Results were reported as odds ratios (ORs) with 95% CIs. RESULTS: We analyzed 13,613 patients (64% female) with RA and 1116 patients (57% female) with PsA. Female patients with RA were more likely to receive opioids (OR 1.39, 95% CI 1.22-1.58 to OR 1.51, 95% CI 1.32-1.72) and NSAIDs (OR 1.14, 95% CI 1.04-1.25 to OR 1.16, 95% CI 1.04-1.30). Dispensation of DMARDs showed no sex difference in either group. Subgroup analyses showed more intense use of advanced therapy in the RA cohort and of csDMARDs in the PsA cohort when patient and physician sex was concordant. CONCLUSION: This study did not identify any sex difference in the use of DMARDs among older patients with RA and PsA. The reasons for the higher use of opioids and NSAIDs among female patients with RA warrant further research.
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Anti-Inflammatory Agents, Non-Steroidal , Antirheumatic Agents , Arthritis, Psoriatic , Arthritis, Rheumatoid , Humans , Female , Male , Aged , Antirheumatic Agents/therapeutic use , Retrospective Studies , Arthritis, Rheumatoid/drug therapy , Arthritis, Psoriatic/drug therapy , Ontario/epidemiology , Sex Factors , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aged, 80 and over , Analgesics, Opioid/therapeutic useABSTRACT
Osteoporosis and fragility fractures are managed by clinicians across many medical specialties. The key competencies of clinicians delivering bone health care have not been systematically established. We aimed to develop a decision rule to define the threshold of adequate skills and attributes associated with clinical competency in bone health for a clinician serving as a referral source for bone health care. Using a modified-Delphi method, we invited clinicians with expertise in treating osteoporosis and representatives of patient advocacy groups focused on bone health to create a list of desirable characteristics of a clinician with bone health competency. Characteristics were defined as "attributes" with "levels" within each attribute. Participants prioritized levels by perceived importance. To identify the cut points for defining adequate competency, participants next ranked 20 hypothetical clinicians defined by various levels of attributes from highest to lowest likelihood of having adequate bone health competency. Lastly, we conducted a discrete choice experiment (DCE) to generate a weighted score for each attribute/level. The threshold for competency was a priori determined as the total weighted score at which ≥70% of participants agreed a clinician had adequate bone health competency. Thirteen participants generated lists of desirable characteristics, and 30 participants ranked hypothetical scenarios and participated in the DCE. The modified-Delphi exercise generated 108 characteristics, which were reduced to 8 categories with 20 levels with associated points. The maximum possible score was 25 points. A summed threshold score of >12 points classified a clinician as having adequate bone health competency. We developed a numeric additive decision rule to define clinicians across multiple specialties as having adequate competency in managing bone health/osteoporosis. Our data provide a rigorously defined criteria for a clinician with competency in bone health and can be used to quantitate the skills of clinicians participating in bone health research and clinical care.
Osteoporosis and fragility fractures are managed by clinicians across many medical specialties. The key skills of clinicians delivering bone health care have not been systematically established. We invited clinicians with expertise in treating osteoporosis and representatives of patient advocacy groups focused on bone health to create a list of desirable characteristics of a clinician with bone health competency. Participants next ranked 20 hypothetical clinicians defined by various characteristics from highest to lowest likelihood of having adequate bone health competency. Lastly, we generated a weighted score for each characteristic. The threshold for competency was determined as the total weighted score at which ≥70% of participants agreed a clinician had adequate bone health competency. The maximum possible score was 25 points, and a summed threshold score of >12 points classified a clinician as having adequate bone health competency. Our data provide a rigorously defined criteria for a clinician with competency in bone health and can be used to quantitate the skills of clinicians participating in bone health research and clinical care.
Subject(s)
Clinical Competence , Osteoporosis , Humans , Osteoporosis/therapy , Female , Male , Osteoporotic Fractures/therapy , Middle Aged , AdultABSTRACT
OBJECTIVE: To examine disease and target engagement biomarkers in the RISE-SSc trial of riociguat in early diffuse cutaneous systemic sclerosis and their potential to predict the response to treatment. METHODS: Patients were randomized to riociguat (n = 60) or placebo (n = 61) for 52 weeks. Skin biopsies and plasma/serum samples were obtained at baseline and week 14. Plasma cyclic guanosine monophosphate (cGMP) was assessed using radio-immunoassay. Alpha smooth muscle actin (αSMA) and skin thickness were determined by immunohistochemistry, mRNA markers of fibrosis by qRT-PCR in skin biopsies, and serum CXC motif chemokine ligand 4 (CXCL-4) and soluble platelet endothelial cell adhesion molecule-1 (sPECAM-1) by enzyme-linked immunosorbent assay. RESULTS: By week 14, cGMP increased by 94 ± 78% with riociguat and 10 ± 39% with placebo (p < 0.001, riociguat vs placebo). Serum sPECAM-1 and CXCL-4 decreased with riociguat vs placebo (p = 0.004 and p = 0.008, respectively). There were no differences in skin collagen markers between the 2 groups. Higher baseline serum sPECAM-1 or the detection of αSMA-positive cells in baseline skin biopsies were associated with a larger reduction of modified Rodnan skin score from baseline at week 52 with riociguat vs placebo (interaction P-values 0.004 and 0.02, respectively). CONCLUSION: Plasma cGMP increased with riociguat, suggesting engagement with the nitric oxide-soluble guanylate cyclase-cGMP pathway. Riociguat was associated with a significant reduction in sPECAM-1 (an angiogenic biomarker) vs placebo. Elevated sPECAM-1 and the presence of αSMA-positive skin cells may help to identify patients who could benefit from riociguat in terms of skin fibrosis. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02283762.
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OBJECTIVE: Systemic sclerosis (SSc) can restrict employment participation. Our objectives were to comparatively evaluate health factors, work factors, and workplace accommodations between those who are employed and those who recently gave up employment. METHODS: A cross-sectional study was conducted of employed and recently working, but now unemployed, individuals with SSc. Demographics, employment sectors, health factors, flare frequency, work context, and information about the need, availability, and use of workplace supports were collected. RESULTS: Participants were 140 individuals (108 [77.1%] women, 32 [22.9%] men), of whom 110 (78.6%) were employed and 30 (21.4%) were unemployed. Participants worked in education/health/sciences/arts (n = 51, 36.4%), sales/retail (n = 23, 16.5%), banking/insurance/business/technology (n = 22, 15.7%), government (n = 15, 10.7%), construction/utilities (n = 10, 7.1%), and manufacturing/agriculture/mining/logging (n = 10, 7.1%). Employed participants had a lower mean age (48.4 vs 54.3 yrs), and higher level of education (77.3% with postsecondary education vs 22.7% without). Those who had no flares were more frequently employed (41.7%), compared to those who had 1 to 2 flares (35.2%) and ≥ 3 flares (23.1%). The availability of workplace accommodations differed significantly between the employed and unemployed: flexible hours (74.5% vs 40%, P = 0.0005), more rest periods (73.6% vs 46.7%, P = 0.0001), special equipment (82.7% vs 46.7%, P < 0.0001), and work schedule flexibility (66.4% vs 33.3%, P = 0.003). CONCLUSION: Health factors alone do not differentiate those who are employed and those who gave up employment. This study lays the groundwork for where SSc-specific efforts in workplace policies and practices should be directed, especially workplace support.
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Employment , Scleroderma, Systemic , Workplace , Humans , Female , Male , Middle Aged , Cross-Sectional Studies , Employment/statistics & numerical data , Adult , Unemployment/statistics & numerical dataABSTRACT
BACKGROUND: The Outcome Measures in Rheumatology (OMERACT) Systemic Lupus Erythematosus (SLE) Working Group held a Special Interest Group (SIG) at the OMERACT 2023 conference in Colorado Springs where SLE collaborators reviewed domain sub-themes generated through qualitative research and literature review. OBJECTIVE: The objective of the SIG and the subsequent meetings of the SLE Working Group was to begin the winnowing and binning of candidate domain sub-themes into a preliminary list of candidate domains that will proceed to the consensus Delphi exercise for the SLE COS. METHODS: Four breakout groups at the SLE SIG in Colorado Springs winnowed and binned 132 domain sub-themes into candidate domains, which was continued with a series of virtual meetings by an advisory group of SLE patient research partners (PRPs), members of the OMERACT SLE Working Group Steering Committee, and other collaborators. RESULTS: The 132 domain sub-themes were reduced to a preliminary list of 20 candidate domains based on their clinical and research relevance for clinical trials and research studies. CONCLUSION: A meaningful and substantial winnowing and binning of candidate domains for the SLE COS was achieved resulting in a preliminary list of 20 candidate domains.
Subject(s)
Lupus Erythematosus, Systemic , Rheumatology , Humans , Public Opinion , Outcome Assessment, Health Care , Lupus Erythematosus, Systemic/therapy , ConsensusABSTRACT
Aim: This study aims to assess the effect of iron on oral health status among the general population residing in high and low levels of iron blocks in the Namakkal district of Tamil Nadu, India. Materials and Method: A cross-sectional study was conducted to assess the impact of iron on oral health among people in the Namakkal district of Tamil Nadu, India. The sample size was estimated to be 600, which were equally divided into two groups based on the high and low levels of iron (300 samples) content of water in the Namakkal district based on the multistage random sampling method. A pre-tested structured questionnaire was used to collect the demographic data and oral hygiene practices of the people. Dental stains were recorded using a modified Lobene stain index. P value < 0.05 was considered to be statistically significant. Results: The area and intensity of the dental stains were not significant with age, gender, and blocks. There was no statistically significant difference between the high iron and low iron blocks for the area (A), intensity (I), and I × A of stains. Conclusion: The study concludes that the water samples with both high and low levels of iron had a strong impact on the oral health of the people.
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Aim: The aim of this study is to analyze the prevalence of oral health status among the general population in Kallakurichi district, Tamil Nadu, India. Materials and Methods: A descriptive cross-sectional study was conducted among the general public in the Kallakurichi district. A total number of 176 samples were selected and equally divided among urban (88 samples) and rural areas (88 samples). The samples were obtained from various parts of urban and rural areas in the Kallakurichi district based on the multistage random sampling method. The data regarding oral health status was recorded using the World Health Organization (WHO) Proformas 2013 and 1997. The collected data were tabulated and analyzed using the Chi-square test. Results: The prevalence of dental caries (74.1%) was found to be the highest in the Kallakurichi district, followed by malocclusion (71.7%) and periodontal diseases (66.7%). A significant result was found in dental caries, dental fluorosis, dental trauma, and dental erosion between the index age groups. Conclusion: The government of Tamil Nadu should take proper preventive measures and also provide oral health knowledge and awareness among the public to overcome these dental problems.
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Aim: The aim of this study was to evaluate the fluoride levels in groundwater and their effect on oral health status among the general population of Erode district, Tamil Nadu, India. Materials and Methods: A descriptive cross-sectional study was conducted among the general population of index age groups 5, 12, 15, 35-44, and 65-74 years. A total of 540 subjects participated in the study. High fluoride blocks of Erode district were selected based on the Central Ground Water Board (CGWB), Ministry of Jal Shakti, Department of Water Resources, River Development and Ganga Rejuvenation, Government of India, 2010, and the low fluoride were taken from the Groundwater Year Book (GWYB) of Tamil Nadu and UT of Puducherry, 2018. The Oral Health Assessment Form 2013 (adult and children) of the World Health Organization (WHO) was used to assess dental caries and enamel fluorosis. Clinical examination was performed using a mouth mirror and explorer under natural illumination by a single examiner. Data obtained were processed and analyzed using IBM SPSS Statistics version 26. A Chi-squared test was employed to analyze the difference between the high and low fluoride blocks. A P value of 0.05 was set to be statistically significant. Results: The current study had a contrary finding with the CGWB on water quality analysis of fluoride levels in drinking water for high fluoride block, Ammapet (1.12 ppm) and Anthiyur (1.08 ppm). The prevalence of enamel fluorosis in high fluoride block Ammapet was 44.4% and Anthiyur was 54.8%. The prevalence of dental caries in high fluoride block Ammapet was 45.9% and in Anthiyur was 43%. The prevalence of enamel fluorosis in low fluoride block Bhavanisagar was 27.4% and in Gobichettipalayam was 28.2%. The prevalence of dental caries in low fluoride block Bhavanisagar was 61.5%, and in Gobichettipalayam was 54.8%. Conclusion: This study's contradictory finding emphasizes the importance of drinking water; sanitation staff should monitor and report water fluoridation data on a monthly basis in accordance with the Water Fluoridation Reporting System, and CGWB should plan and organize a team for the upgradation of water quality in India. The National Program for Prevention and Control of Dental Diseases should look on to the endemic areas for the prevention of dental fluorosis, which should be assessed, implemented, and monitored by the public health dentist who should be recruited as oral health program officers in both central and state governments.
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Apical periodontitis is an inflammation and destruction of the periradicular tissues due to various insults to the pulp in the form of infection, trauma, and faulty dental procedures. Conditions regarding this are treated employing root canal therapy. Recent innovations show that copper calcium hydroxide nanoparticles and their electrophoresis can be used to treat apical periodontitis effectively. To evaluate the effectiveness of copper calcium hydroxide nanoparticles in the treatment of apical periodontitis, a literature search was done using PubMed, Cochrane Central Register of controlled Trials (CENTRAL), Science Direct, and Lilacs using the MeSH (Medical Subject Heading) terms Copper calcium hydroxide, apical periodontitis, nanoparticles, and electrophoresis. Of a total of 167 articles screened, 44 were full-text articles assessed for eligibility and four articles were taken for the qualitative analysis. This review was recorded according to the PRISMA GUIDELINES. Four randomized controlled trials were included in the review process. The copper calcium hydroxide particles were compared with other root canal medicament materials. It was found that copper calcium hydroxide and its electrophoresis were used in the treatment of apical periodontitis and were found to be one of the effective methods. Copper calcium hydroxide nanoparticles were effective against the destruction of the periradicular tissues.
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Class II mandibular furcation defect is a periodontal condition characterized by a cul-de-sac lesion, a definite parallel constituent with only a portion of alveolar bone remaining intact. There may be involvement of vertical bone loss. Local drug deliveries such as Boric acid, alendronate gel, and other drugs exhibited anti-inflammatory, antibacterial & osteoblastic differentiation activity. The present systematic review compares the drugs based on their outcomes and pharmacological action. To analzse & compare various forms of local drug delivery systems on a class II furcation. A search was conducted using PubMed, Google scholar, science direct, and Pub Med central using MeSH terms - local drug delivery in periodontics, boric acid in the management of class II mandibular furcation, simvastatin in the treatment of furcation. A total of 560 articles were screened; 58 out of 560 were full-text articles accessed for eligibility, and five articles were included in the systematic review. PRISMA guidelines were used for reporting this review. In addition, five randomized controlled trials were enclosed and used in this systematic review. The various local drugs used in treating class II mandibular furcation defects are effective in the prevention of bleeding on probing, bone resorption, gingival bleeding index and increase in the bone fill, and microbial deposit removal. The managing of class II mandibular furcation defect with the drugs mentioned in this review can be effective by reducing several clinical parameters such as bleeding on probing, gingival indices, osteoblastic differentiation, bone fill, etc., Considering the results of the studies, it can be concluded that it can be used as a therapeutic therapy against class II furcation defects with positive outcomes.
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Multiple myeloma is a malignant cancerous condition that is characterized by abnormal plasma cell production and can lead to bone destruction due to increased osteoclastic activity and decreased osteoblastic activity. Many therapeutic therapies are used to treat diseases, such as chemotherapy and radiotherapy. In recent years, anti-sclerostin antibody treatment has been under investigation for its effect on the multiple myeloma. The present study was conducted to assess the effective therapeutic use of anti-sclerostin antibody in the treatment of multiple myeloma. The literature search was conducted using PubMed, Google Scholar, ScienceDirect, and PubMed Central using the following MeSH terms: "multiple myeloma", "anti-sclerostin antibody", "ubiquitin-proteasome pathway", "proteasome inhibitor", "Wnt pathway". A total of 348 articles were screened. Twenty-five out of 348 were full-text articles assessed for eligibility, and four articles were used in this systematic review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the reporting of this systematic review. A total of four randomized control trials (RCT) were included and used in this systematic review. The anti-sclerostin antibodies were various other drugs, and it was found that the anti-sclerostin antibody was effective in preventing autoantibody formation, decreasing bone destruction, and increasing trabecular bone. Anti-sclerostin antibody was found to be effective in decreasing bone destruction by reducing osteoclastic activity and increasing osteoblastic activity associated with multiple myeloma.
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Aim: The aim of this study is to assess the prevalence oral health status among the general population residing in Kanyakumari district, Tamil Nadu, India. Materials and Method: A descriptive cross-sectional study was conducted among the general public of index age groups to analyze the oral health status in the Kanyakumari district. A total number of 400 samples were selected and were equally divided among urban (200 samples) and rural areas (200 samples). The samples were further divided randomly based on the index age groups 5, 12, 15, 35-44, and 65-74 years using the multistage random sampling method. The data regarding oral health status was recorded using the World Health Organization's (WHO's) Oral Health Assessment Form 2013 and 1997. Collected data were tabulated and analyzed using descriptive statistics and the Chi-squared test. Results: The prevalence of periodontal diseases (88.75%) was found to be highest in Kanyakumari district, followed by dental caries (63.7%) and malocclusion (63.1%). There was a statistically significant difference found between oral health status and index age groups. Conclusion: Oral disorders such as dental caries, periodontitis, and dental fluorosis are more prevalent among the Kanyakumari district population. Oral health policies should be targeted to the populations in the Tamil Nadu region.
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Hypophosphatasia (HPP) is a life-threatening disease that occurs due to the mutation of the TNSALP (Tissue nonspecific isoenzyme of alkaline phosphatase) encoding gene. There is no approved treatment for Hypophosphatasia. Therefore, the only effective treatment for HPP is enzyme replacement therapy using the drug asfotase alfa which increases the patient's life span. The aim of the study is to evaluate the effectiveness and safety of asfotase alfa (enzyme replacement therapy) in treating HPP. A Literature search was done using PubMed, Google scholar, science direct, and Wiley LILACS utilizing MeSH keywords such as - Hypophosphatasia and asfotase alfa. A total of 411 articles were screened, of which four articles were taken for this qualitative analysis. Reporting of this systematic review is done by using PRISMA guidelines. Asfotase alfa/enzyme replacement therapy is examined on patients with different age groups and on congenital HPP patients to assess the effectiveness of HPP treatment. Enzyme replacement therapy using asfotase alfa is an effective and assured treatment for infants, children, and adults suffering from HPP.
