Opioid Dose Reductions by Sex and Race in a Cohort of Patients in a Family Medicine Clinic.

BACKGROUND: The 2022 Centers for Disease Control's "Clinical Practice Guidelines for Prescribing Opioids for Pain in United States" called for attention and action toward reducing disparities in untreated and undertreated pain among Black and Latino patients. There is growing evidence for controlled substance safety committees (CSSC) to change prescribing culture, but few have been examined through the lens of health equity. We examined the impact of a primary care CSSC on opioid prescribing, including by patients' race and sex. METHODS: We conducted a retrospective cohort study. Our primary outcome was a change in prescribed morphine milligram equivalents (MME) at baseline (2017) and follow-up (2021). We compared the differences in MME by race and sex. We also examined potential intersectional disparities. We used paired t test to compare changes in mean MME's and logistic regression to determine associations between patient characteristics and MME changes. RESULTS: Our cohort included 93 patients. The mean opioid dose decreased from nearly 200 MME to 136.1 MME, P < .0001. Thirty percent of patients had their dose reduced to under 90 MME by follow-up. The reduction rates by race or sex alone were not statistically significant. There was evidence of intersectional disparities at baseline. Black women were prescribed 88.5 fewer MME's at baseline compared with their White men counterparts, P = .04. DISCUSSION: Our findings add to the previously documented success of CSSCs in reducing opioid doses for chronic nonmalignant pain to safer levels. We highlight an opportunity for primary care based CSSCs to lead the efforts to identify and address chronic pain management inequities.

Resolution of Apical Periodontitis-induced Mental Nerve Paresthesia Through Nonsurgical Endodontic Retreatment: A Case Report.

Paresthesia is a potential consequence of unsuccessful root canal treatment. Persistent infection resulting in apical periodontitis may enlarge sufficiently to involve the mental neurovascular bundle. The case presented in this report was referred for endodontic evaluation with a chief complaint of discomfort on mastication and persistent numbness of the lower left lip. Clinical and radiographic evaluation revealed incomplete primary endodontic treatment of the left mandibular second premolar with complex internal anatomy. The untreated root canal system resulted in the progression of apical periodontitis involving the left mental neurovascular bundle as confirmed by cone-beam computed tomography imaging. Nonsurgical root canal retreatment was performed over 2 visits. At the 3-year follow-up visit, the paresthesia had resolved with return of normal sensation. Nonsurgical endodontic retreatment may be sufficient to allow healing of large periapical lesions and resolve complications including paresthesia without the need for surgical intervention.

Root and canal morphology of maxillary second molars in a Black South African subpopulation using cone-beam computed tomography and two classifications.

This study investigated the root and canal morphology of maxillary second molars in a Black South African population using high-resolution cone-beam computed tomography. In total, 386 maxillary second molar teeth were evaluated and described according to the classifications of Vertucci (with the additions of Sert and Bayirli), as well as Ahmed et al. Root number, fusions and canal morphology were recorded. Relationships between morphology, sex and age were assessed using Fisher's exact test (p < 0.05). Maxillary second molars were predominantly three-rooted (96.1%), with root fusion observed in 14%. No relationships between sex, age and canal morphology were found. Additional canals were observed in 67.4% of mesiobuccal roots. The Ahmed et al. classification provided a better overall description of the morphology. In this population, maxillary second molar teeth exhibited a diversity of root and canal morphology. Complex variations may render endodontic management more difficult and increase the possibility of missed anatomy.

Double Gemination or Fusion of a Permanent Mandibular Second Molar: A Case Report.

Gemination and fusion are developmental conditions affecting the shape of teeth in both primary and permanent dentition. A 12-year-old girl presented for clinical assessment and the examination revealed an unusually shaped mandibular right second molar with irreversible pulpitis. Correlation of the intraoral and radiological appearance of this tooth suggested a diagnosis of either double gemination or fusion. The favourable position of the developing third molar supported early extraction of the abnormal second molar. The present report documents the clinical and radiological presentation of a mandibular second molar with an unusual developmental alteration in shape. Well-timed extraction therapy and good communication may reduce the need for unnecessary, complex treatment.

PTEN protein expression has role in predicting disease-free-interval in endometrioid endometrial carcinoma.

OBJECTIVES: To determine the significance of tumour PTEN protein expression in endometrioid endometrial carcinoma (EEC) and it is correlation with tumour characteristics. METHODS: A total of 30 eligible archived paraffin-embedded tissue blocks from 61 EEC cases (January 2015-December 2017) were retrieved from the Histopathology Laboratory in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) following institutional ethic approval. For PTEN protein detection, immunohistochemistry (IHC) staining was performed and the data was correlated with clinicopathologic parameters. RESULTS: Fourteen samples (46.7%) showed positive PTEN protein expression, while 16 (53.3%) were negative. The mean age was 62.00 ± 9.51 years old, while the mean Body Mass Index (BMI) was 27.28 ± 7.16 kg/m2. There was no significant difference between age (p=0.27, 95% CI: -10.98 to 3.21) and BMI (p=0.67, 95% CI: -4.30 to 6.58) with PTEN protein expression. There were significant correlation between PTEN protein expression with myometrial invasion (p=0.010), but not with lymphovascular space invasion (p=0.743), grade (p=0.532), stage (p=0.733) and CA-125 level (p=0.47). The higher stage correlates with the presence of LVSI (p=0.002). PTEN positive associated with longer disease-free-interval (p=0.025), but not improving the overall survival (p=0.38). CONCLUSIONS: Positive PTEN protein expression correlates with less myometrial invasion.

Endodontic treatment of dentin dysplasia type I D.

Dentin dysplasia (DD) Type I is a developmental condition affecting dentin, inherited in an autosomal-dominant pattern or occurring due to a new mutation. Whilst the crowns of DD Type I affected teeth appear clinically normal, the roots are blunt and shortened. Pulp necrosis and periapical pathoses may be seen in the absence of obvious causes. Pulp stones and calcifications are frequently encountered. Endodontic management of DD may be challenging. A case of DD Type I, sub-classification d, in which spontaneous irreversible pulpitis developed on three mandibular incisors is documented. The case was managed by conventional endodontic treatment. Knowledge of this uncommon dental condition may assist dentists to adequately diagnose and manage these cases. Extraction should not be considered the first-line treatment option when sufficient root length is available to attempt endodontic treatment. Referral for medical evaluation is recommended to rule out systemic diseases which may mimic this condition.

Association between dietary intake, physical activity and stress level with constipation among undergraduate students

@#Introduction: Constipation is one of the most common health problems among university students. This study aims to determine the association between sociodemographic characteristics, dietary intake, physical activity, and stress level with constipation among undergraduate students. Methods: The study was a crosssectional study and the participants comprised of 140 undergraduate students (27.9% males and 72.1% females). A 3-day dietary record was obtained to determine energy, fibre and fluid intakes, while physical activity was determined using the International Physical Activity Questionnaire. Stress level and constipation were assessed using the Cohen’s Perceived Stress Scale and Agachan’s Constipation Score System Questionnaire, respectively. Data were analysed using IBM SPSS Statistics version 23. Multivariate linear regression analysis was done to determine factors that were associated with constipation. Results: Mean age of the participants was 20.9±1.5 years old and majority were third year students (32.1%). Mean intakes of energy, dietary fibre, and fluids per day were 1567±438kcal, 5.6±3.5g, and 2301±946ml, respectively. The median score for physical activity was 1135.5 METminutes/week. Most of the participants (77.1%) had a high or a very high stress level and 64.3% had slight constipation. Age, dietary fibre, fluid, energy, and perceived stress scale explained a significant amount of the variance in the occurrence of constipation [F(6.133)=16.373, p<0.001, R2=0.425, R2Adjusted=0.399]. Conclusion: Age, energy, fluid and fibre intakes, as well as perceived stress were factors that were associated with constipation among undergraduate students. Therefore, undergraduate students should be encouraged to practise a healthy lifestyle to modify these identified risk factors.

Tongue-tied: a case of magnetic balls constricting the lingual frenum.

The health risks associated with aspiration and ingestion of foreign bodies in children are well known. The increased availability of magnetic toys have added to these risks. A 7-year-old girl presented at the Department of Maxillofacial and Oral Surgery at the University of Pretoria Oral and Dental Hospital with a complaint of pain under the tongue. Examination revealed that magnetic balls had been lodged on either side of the lingual frenum. The patient experienced pain and was unable to dislodge the magnets. This case report documents patient presentation and management and concludes with a brief discussion of potential complications associated with the oral intake of magnets. Though multiple cases documenting the complications associated with ingestion of magnets have been reported, reports of primary oral complications are scant. This case contributes to existing evidence for the dangers associated with high strength magnets used as toys by children.

Allergic contact dermatitis from resin-modified glass ionomers.

Monomers in a variety of dental materials may cause allergic contact dermatitis. While resin materials have been implicated in the onset of this condition, there is a paucity of evidence linking the condition to the resin-modified glass ionomers (RMGIs). This report documents a rare case of a dentist who developed allergic contact dermatitis following exposure to a RMGI. Contact dermatitis occurred despite the use of latex gloves, which were worn during the procedure. Both the acute and chronic stages of the condition were clinically represented. Patch testing was conducted to confirm the diagnosis. A no-touch technique and the routine use of nitrile gloves were subsequently adopted, which resulted in an overall decrease of the condition. Dentists, auxiliary personnel, and students should be aware of the possibility of sensitization to, and the development of allergic contact dermatitis not only from conventional resin materials, but also from the RMGIs.

Cytomorphologic patterns of breast lesions in Sudanese patients: lessons learned from fine needle aspiration cytology.

BACKGROUND: Cytology for breast lesions is a safe, rapid and cost-effective with a high specificity and sensitivity. OBJECTIVE: To determine the cytomorphologic patterns of breast lesions identified among a group of Sudanese patients. MATERIALS AND METHODS: This study included 759 patients undergoing either a fine needle aspiration FNA, nipple discharge (ND) smears or breast skin scraping (SS) at a cytology clinic in Khartoum. Clinical and demographic data were reviewed. Stained smears were categorized into: inadequate sample, normal breast, benign lesion, suspicious, or malignant neoplasm. RESULTS: of the 759 cases, 734 (96.71%) were FNA, 18 (2.37%) ND and 7 cases (0.92%) SS. For 28 cases, FNA was done under ultrasound guidance. Females were 720 (94.86%). Benign lesions were 423(55.75%) and 248 (32.67%) were malignant and 77 (10.14%) of smears were normal without any detected abnormality. Ten (1.31%) cases were suspicious for malignancy, and only one case (0.13%) was reported as inadequate. Most lesions were observed among the age group 30 years and above. CONCLUSION: Most patients investigated have benign lesions, one third of cytological smears were malignant. FNAC is a useful tool for investigating breast lesions in limited-resource settings.

Assessing mixed trace elements in groundwater and their health risk of residents living in the Mekong River basin of Cambodia.

We investigated the potential contamination of trace elements in shallow Cambodian groundwater. Groundwater and hair samples were collected from three provinces in the Mekong River basin of Cambodia and analyzed by ICP-MS. Groundwater from Kandal (n = 46) and Kraite (n = 12) were enriched in As, Mn, Ba and Fe whereas none of tube wells in Kampong Cham (n = 18) had trace elements higher than Cambodian permissible limits. Risk computations indicated that 98.7% and 12.4% of residents in the study areas of Kandal (n = 297) and Kratie (n = 89) were at risk of non-carcinogenic effects from exposure to multiple elements, yet none were at risk in Kampong Cham (n = 184). Arsenic contributed 99.5%, 60.3% and 84.2% of the aggregate risk in Kandal, Kratie and Kampong Cham, respectively. Sustainable and appropriate treatment technologies must therefore be implemented in order for Cambodian groundwater to be used as potable water.

Arsenic concentration in rice, fish, meat and vegetables in Cambodia: a preliminary risk assessment.

To assess arsenic contaminations and its possible adverse health effects, food samples were collected from Kandal, Kratie and Kampong Cham in Cambodia. The highest and the lowest concentrations were observed in fish (mean 2,832 ng g(-1), ww) collected from Kandal province and cattle stomach (1.86 ± 1.10 ng g(-1), ww) collected from Kratie, respectively. The daily intake of arsenic via food consumption was 604, 9.70 and 136 µg day(-1) in Kandal, Kratie and Kampong Cham, respectively. The arsenic dietary intake in Kandal ranked No. 1 among all the 17 compared countries or regions. Fish consumption contributed the greatest proportion of total arsenic daily intake in Kandal (about 63.0 %) and Kampong Cham (about 69.8 %). It is revealed to be a much more important exposure pathway than drinking water for residents in Kampong Cham. The results of risk assessment suggested that the residents in Cambodia, particularly for people in Kandal province, suffer high public health risks due to consuming arsenic-contaminated food.

Daily intake and human risk assessment of organochlorine pesticides (OCPs) based on Cambodian market basket data.

To assess organochlorine pesticide (OCP) contaminations and its possible adverse health impacts, different food samples were collected from three areas of Cambodia, one of the poorest countries in the world. The ∑OCP concentrations in Kampong Cham, Kratie and Kandal provinces ranged from 1.28 to 188 (median 3.11), 1.06 to 25.1 (5.59) and 2.20 to 103 (20.6) ng g(-1), respectively. The dichlorodiphenyltrichloroethanes (DDTs) were the predominant OCPs and accounted for 62.2% (median) among all foodstuffs. Congener profile analyses suggested that there were new input sources of DDTs and hexachlorocyclohexanes (HCHs) in Cambodia, particularly in Kandal province. The estimated daily intake of OCPs (330 ng kg(-1)day(-1)) for residents in Kandal province ranked No. 1 among the 13 compared countries or regions. On the basis of 95th percentile concentrations, the carcinogenic hazard ratios (HRs) of most investigated individual OCPs in vegetable and fish in Cambodia exceeding unity. Particularly for α-HCH in vegetable, the 95th HR was as high as 186. The data revealed that there is a great cancer risk for the local residents with life time consumption of OCP contaminated vegetable and fish. To our knowledge, this the first study to evaluate the daily intakes of OCPs in Cambodia.

Health risk assessment of inorganic arsenic intake of Cambodia residents through groundwater drinking pathway.

In order to compare the magnitudes and health impacts of arsenic and other toxic trace elements in well water, groundwater and hair samples were collected from three areas with different arsenic exposure scenarios in the Mekong River basin of Cambodia. Ampil commune in Kampong Cham province was selected as an uncontaminated area, Khsarch Andaet commune in Kratie province was selected as a moderately contaminated area, and Kampong Kong commune in Kandal Province was selected as an extremely contaminated area. Results of ICP-MS analyses of the groundwater samples revealed that As, Mn, Fe and Ba concentrations were significantly different among the three study areas (Kruskal-Wallis test, p < 0.0001). Out of 46 observed wells in the Kandal province study area, 100% detected As > 50 µg L(-1) and Fe > 300 µg L(-1); 52.17% had Mn > 400 µg L(-1) and 73.91% found Ba > 700 µg L(-1). In the Kratie province study area (n = 12), 25% of wells showed elevated arsenic levels above 10 µg L(-1) and 25% had Mn > 400 µg L(-1), whereas samples from Kampong Cham province study area (n = 18) were relatively clean, with As < 10 µg L(-1). A health risk assessment model derived from the USEPA was applied to calculate individual risks resulting from drinking groundwater. Computational results indicated that residents from Kandal Province study area (n = 297) confronted significantly higher non-carcinogenic and carcinogenic risks than those in Kratie (n = 89) and Kampong Cham (n = 184) province study areas (Kruskal-Wallis test, p < 0.0001). 98.65% of respondents from the Kandal province study area were at risk for the potential non-cancer effect and an average cancer risk index was found to be 5 in 1000 exposure. The calculations also indicated that, in the Kratie province study area, 13.48% of respondents were affected by non-cancer health risks and 33.71% were threatened by cancer, whereas none of respondents in the Kampong Cham province study area appeared to have non-carcinogenic effect. Positively significant correlations of the arsenic content in scalp hair (As(h)) with both arsenic levels in groundwater (As(w)) (r(s) (304) = 0.757, p < 0.0001) and individual average daily doses (ADD) of arsenic (r(s) (304) = 0.763, p < 0.0001) undoubtedly indicated that arsenic accumulation in the bodies of Cambodia residents in the Mekong River basin was mainly through a groundwater drinking pathway. To the best of our knowledge, this is the first comprehensive report comparing individual health risk assessments of arsenic exposure through a groundwater drinking pathway to enriched arsenic levels from groundwater in the Mekong River basin, Cambodia. This study indicates that elevated arsenic concentrations in groundwater may lead to thousands of cases of arsenicosis in the near future if mitigating actions are not taken.