Effects of continuous erythropoietin receptor activator (CERA) in kidney transplant recipients.

Erythropoietin-stimulating agents (ESAs) are commonly used to treat anemia in kidney transplant recipients (KTRs). Since 2007, continuous erythropoietin receptor activator (CERA) has been one of the newest recombinant ESAs to treat anemia in dialysis and nondialysis patients with chronic kidney disease. The efficacy of CERA to manage anemia has not been extensively evaluated in KTRs. We evaluated safety, efficacy, and satisfaction among KTRs treated with CERA. We enrolled 19 anemic KTRs (60 ± 9.3 y) who were treated with short-acting ESA for ≥24 weeks. They were shifted to the equivalent dose of CERA and followed for 24 weeks. We measured serum hemoglobin, hematocrit, creatinine, iron, ferritin, and transferrin. To investigate tolerance to and satisfaction with short-acting ESA and CERA, questionnaires were administered to the patients before shifting to CERA and at the end of the follow-up. After 6 months, CERA induced an increase in hemoglobin levels (12.3 ± 0.8 vs 11.2 ± 1.1 g/dL; P = .002, CERA vs short-acting ESA, respectively). In 2 patients treatment was discontinued because the hemoglobin increased to >13 g/dL. No significant differences were observed in serum iron and creatinine between short-acting ESA and CERA throughout the study. The questionnaires showed better compliance to CERA treatment with reduced pain at the injection site, which led subjects to prefer CERA to short-acting ESA. In summary, CERA showed better control of anemia compared with short-acting ESA. It was preferred by the majority of patients, mainly because of the reduced number of monthly injections. Our results demonstrated CERA to be effective, safe, and well tolerated in the management of anemia in KTRs.

Epidemiology of dental professional liability.

The aim of this article is to collect data relating to dental professional liability in Italy and provide a common platform for discussions among clinicians, legal medicine practitioners, and experts in law. On the basis of two different dental-legal statistical samples (1,670 reports of legal dental experts and 320 civil court decisions) we analyzed the dental professional liability lawsuit in the areas of distribution of lawsuits among the different dental specialties, recurrence and type of errors, outcome of civil suits, parameters of compensation. Some ideas are also proposed for possible strategies in the management of clinical risk (prevention of errors) and court proceedings.

Temporomandibular disorders assessment: medicolegal considerations in the evidence-based era.

Summary Temporomandibular disorders (TMD) are a frequent finding in cases of facial trauma or dental malpractice, and legal claims for TMD damage have been increased over the years. Temporomandibular disorders assessment in the medical legal setting is complicated by the peculiarities of these disorders, whose symptoms are heterogeneous, fluctuant, and recognise a multifactorial origin. A systematic Medline search in the National Library of Medicine's PubMed database pointed out that, despite the medical legal aspects of the dental profession are gaining a growing attention, there is a paucity of literature dealing with patients with TMD assessment. For these reasons, evidence-based knowledge in the field of TMD diagnosis and treatment was summarised in this article with the aim of providing useful suggestions for a medical legal approach to TMD.

Effects of sirolimus on human mesangial cells.

Mesangial cell (MC) proliferation and production of extracellular matrix or loss of MC are both central findings in a number of renal proteinuric diseases. However, the role of MC as components of the glomerular filtration barrier and whether MC alterations induce changes in the glomerular filtration barrier leading to proteinuria are still matters of debate. The effects of Sirolimus (SRL) in proteinuric nephropathies is controversial: some papers have indicated a reduction and others, an increase in proteinuria after sirolimus treatment. Considering the pivotal role of MC in the pathogenesis of many chronic nephropathies, we evaluated the effect of SRL on cultured human MC. We treated primary human MC cultures with SRL, or platelet-derived growth factor (PDGF) or SRL + PDGF, or dimethylsulfoxide, the SRL vehicle, as a control. PDGF was used to activate MC. After 48 hours treatment, MC showed a significant growth increase that was significantly reduced by SRL (P < .01). Apoptosis, determined by the TUNEL assay and flow cytometry, was not modified by the treatments at 24 hours. SRL treatment increased significantly the number of alpha-smooth muscle actin-positive cells compared with controls (P < .05). Cells treated with SRL and SRL + PDGF showed significant changes in morphology with increased mean cell surface, perimeter, and maximum diameter (P < .01) but not protein content. Furthermore, MC treated with SRL showed decreased migration through polycarbonate membranes. The changes induced by SRL may help to explain some of the in vivo effects observed in SRL-treated patients.

Child abuse and dental neglect: the dental team's role in identification and prevention.

Health, education and social services are placing increasing emphasis on preventing abuse and neglect by early intervention to support families where children and young people may be at risk. Dental hygienist and dental assistants, like all other health professionals, can have a part in recognizing and preventing children from those who would cause them harm. They should be aware of the warning signs, recognizing what to consider as abuse or dental neglect and know how to deal with these young patients, and to fulfil their legal and ethical obligation to report suspected cases. The purpose of this report is to review the oral and dental aspects of child abuse and dental neglect thus helping the dental team in detecting such conditions. In particular, this report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, early childhood caries and diseases that may be indicative of child abuse or neglect. Emphasis is placed on an appropriate protocol to follow in the dental practice to best treat and protect children who may have suffered abuse, helping the team in the diagnosis and documentation.

Professional liability and structure of litigation in dentistry.

This study analyses 101 medico-legal consultations issued in cases of professional liability in dentistry in Italy. The aim was to review professional liability lawsuits against dentists and compare them with previous statistical analyses relating to the past ten years. The results confirm most data from previous dental litigation studies and are comparable to previous studies also for what concerns the type of accident, the assessment of bodily harm, and other adjunctive items (role of insurance and demographics): increased use of dental prostheses (70%) associated with endodontic injury and implant failures in half of the cases; recurrence of a limited number of errors specific for each branch of dentistry; increased defeats in judicial proceedings by medical providers (90%); joint liability in 10% of cases; frequent recourse to judicial proceedings (40%); fewer extrajudicial settlements by insurance companies (25%); predominance of male dentists (mean age 50 years) and middle aged female patients (75%); decreased amounts of damages for bodily harm. The amount of the resultant costs of revision procedures and services required to repair harm have been estimated at Euro 17,757.00 per accident, with a considerable increase of Lire 6,500,000 (Euro 3,356.97) in 1998 (178 cases settled by insurance companies) and Euro 6,539.00 in the period 1998-2004 (75 medico-legal decisions).

Forensic sciences and forensic odontology: issues for dental hygienists and therapists.

The scientific literature contains very little about the role of the dental hygienist/therapist in the specific areas of forensic investigations and collection of evidence. The authors examine how the contribution of a highly qualified dental hygienist can be particularly helpful during human forensic identification operations and non-accidental traumas like domestic violence, child abuse, neglect and bitemarks. Forensic dental identification of human remains is a highly complex multidisciplinary challenge. It requires the involvement of several professionals who are expert in forensic science. Among these, one or more adequately trained dental hygienists could be involved. Dental hygienists/therapists may also be asked to record cutaneous lesions in two different situations. The first may be the dental office where she/he may detect oval, elliptic, or semicircular lesions on the skin of the uncovered neck, shoulder and arms of a patient. The second is the crime scene or the morgue (if one is involved), which may require a visit by the forensic odontologist called by the medical examiner or the coroner to perform an odontological autopsy. The purpose of our study is to highlight procedures that should be followed by the dental hygienist/therapist in collecting forensic information in the above-mentioned scenarios. As a valuable resource, the authors recommend training of dental hygienists in the area of forensic sciences, with particular attention to information technology and photography.