Recent infective endocarditis research findings suggest dentists prescribe prophylactic antibiotics for patients having a bicuspid aortic valve or mitral valve prolapse

Background: The scientific validity of the European Society of Cardiology’s (ESC) infective endocarditis (IE) guidelines limiting provision of prophylactic antibiotics (AP) only to patients having cardiac anomalies (e.g., prosthetic valves) believed to place them at “high risk” of adverse events when undergoing high risk dental procedures (HRDP) is unclear. Material and Methods: A systematic review of studies conducted between 2017 and 2022 and catalogued in the PubMed database was undertaken to ascertain if this edict was associated with changes in IE incidence, development of infection in unprotected cardiac anomalies, developing infection and resultant adverse clinical outcomes. Results: Retrieved were 19 published manuscripts, however of these, 16 were excluded because they did not bare upon the issues of concern. Among the three studies eligible for review were those in the Netherlands, Spain, and England. The results of the Dutch study denoted a significant increase in the incidence of IE cases over the projected historical trend (rate ratio: 1327, 95% CI 1.205-1.462; p<0.001) after the introduction of the ESC guidelines. The findings from the Spanish study evidenced the uniquely high in-hospital IE associated fatality rates suffered by patients having bicuspid aortic valves (BAV); 5.6% or mitral valve prolapse (MVP); 10%. The British study provided evidence that the incidence of fatal IE infection was significantly greater among an “intermediate risk” cohort of patients, (a group likely including those with BAC and MVP for which the ESC guidelines don’t recommend AP), than among “high risk” patients (P = 0.002). Conclusions: Patients having either a BAV or MVP are at significant risk of developing IE and suffering serious sequelae including death. The ESC guidelines must reclassify these specific cardiac anomalies into the “high risk” category so that AP are recognized as being needed prior to provision of HRDP. (AU)

Association of xerostomia and taste alterations of patients receiving antineoplastic chemotherapy: A cause for nutritional concern.

BACKGROUND & AIMS: The symptoms of xerostomia and taste alteration are adverse effects which frequently occur in patients under chemotherapy and once associated they can potentially impair their nutritional status. The aim of this study was to investigate the association of xerostomia and taste alterations in patients being treated by neoplastic chemotherapy. METHODS: Fifty patients scheduled to receive neoplastic chemotherapy were followed for their first two chemotherapy cycles for solid tumors and the Chemotherapy-Induced Taste Alteration Scale (CiTAS) was adopted. Xerostomia was defined by the presence of dry mouth complaints reported by the patients and signs of hyposalivation identified during the intraoral examination. RESULTS: Of the 50 patients, 33 were women, mean age; 61,48 ± 9,07 years, and 17 were men, mean age; 57,35 ± 11,50 years. The most common tumor was located in the breast affecting 15 patients (30%). The Mann-Whitney test showed that the mean scores of CiTAS were significantly higher for those patients who reported having xerostomia when compared with those without xerostomia after the first two chemotherapy cycles. The cofounding variables such as age, smoking habits and use of antidepressants were not statistically associated with taste alterations (p > 0.05). CONCLUSIONS: Taste alterations were worse for patients who complained of xerostomia during the first two cycles of antineoplastic chemotherapy and the association of both symptoms can potentially impair their nutritional status and quality of life.

Elevated White Blood Cell Count Resultant Atherogenesis is Associated With Panoramic-Imaged Carotid Plaque.

PURPOSE: Atherosclerotic plaques develop as a result of a low-grade, chronic, systemic inflammatory response to the injury of endothelial cells arising from lipid deposition within the intima. Increased white blood cell count (WBCC) is both a validated "biologic marker" of the extent of this inflammatory process and a key participant in the development of subsequent atherosclerotic ischemic heart disease manifesting as myocardial infarction. We sought to determine if calcified carotid artery plaque (CCAP) on a panoramic image (PI), also a validated risk indicator of future myocardial infarction, is associated with increased WBCC. PATIENTS AND METHODS: We retrospectively evaluated the PI and medical records of White male military veterans aged 55 years and older treated by a VA dental service. Established were 2 cohorts of patients, 50 having plaques (CCAP+) and 50 without plaques (CCAP-). Predictor variable was CCAP+; outcome variable was WBCC. Bootstrapping analysis determined the differences in mean WBCCs between groups. Statistical significance set at ≤ 0.05. RESULTS: The study group, (mean age 74; range 59 to 91 years) demonstrated a mean WBCC of 8,062 per mm3. The control group, (mean age 72 range; 57 to 94) evidenced a mean WBCC of 7,058 per mm3. Bootstrapping analysis of WBCC values demonstrated a significant (P = .012) difference (95% confidence interval of difference of mean, -806, 742; observed effect size, 1004) between groups. CONCLUSIONS: The presence of CCAP demonstrated on PIs of older Caucasian men is associated with elevated WBCC. Concomitant presence of CCAP on PI and increased WBCC (≥7,800 per mm3) amplifies need for medical consultation before intravenous anesthesia and maxillofacial surgical procedures.

Characteristics of the Filtering Bleb and the Agreement between Glaucoma Specialist and Anterior Segment-Optical Coherence Tomography Assessment.

INTRODUCTION: This study aimed to evaluate the characteristics of the filtering bleb in failed late trabeculectomy and the agreement between glaucoma specialist assessment and anterior segment-optical coherence tomography (AS-OCT) system assessment in terms of the presence of subconjunctival fluid in the filtering bleb. METHODS: Patients with a diagnosis of glaucoma who were scheduled to undergo trabeculectomy in at least one eye and with uncontrolled intraocular pressure (IOP) were enrolled. All participants underwent a complete ophthalmological examination. The presence of fluid under the filtering bleb was first evaluated by a glaucoma specialist using biomicroscopy evaluation and then using the OCT 1000 AS-OCT Version 3.0.1.8 (Carl Zeiss Meditec, Dublin, CA, USA) system. A Kappa statistical test was used to evaluate the agreement between AS-OCT and the examiner. The correlation between conjunctiva and tenon thickness and clinical parameters was also assessed. RESULTS: Forty eyes of 40 patients were evaluated in this study. The ages ranged from 21 to 86 years, with a mean of 66.55 ± 12.33. The average IOP was 21.20 ± 4.44 mm Hg (range 14-38 mm Hg) in the entire group. The mean thickness of the conjunctiva and tenon was 302.03 ± 406.76 µm (range 251-1,616 µm). There was a significant negative correlation between the mean thickness of the conjunctiva and tenon and IOP (p = 0.045; confidence interval = -0.558, 0.024). Additionally, there was a significant negative correlation between the mean thickness of the conjunctiva and tenon, and the number of medications used at baseline (p = 0.043; confidence interval = -0.538, 0.051). There was significant negative correlation between the horizontal measurement of the bleb and the use of glaucoma medications (p = 0.017; confidence interval = -0.560, 0.004). A total of 26 patients were determined to have fluid by the examiner (glaucoma expert), and the presence of fluid in AS was confirmed in 19 patients by AS-OCT. Of the 14 patients who were determined to have an absence of fluid, this was confirmed by AS-OCT in 7 patients (Kappa = 0.231; agreement of 65.00%). CONCLUSION: There is fair agreement between glaucoma specialist assessment and AS-OCT assessment in terms of the presence of fluid in trabeculectomy. Our findings highlight the importance of AS-OCT in some patients before deciding upon a new intervention.

Late Oral Complications Caused by Head and Neck Radiotherapy: Clinical and Laboratory Study.

OBJECTIVES: The aim of presented cross-sectional and observational study was to determine the prevalence of late oral complications of patients with head and neck cancer who underwent radiotherapy, by clinical and laboratory analyses. MATERIAL AND METHODS: Fifty-five patients, 43 (78.2%) men and 12 (21.8%) women, mean age 60; range 38 to 87 years, who have completed radiotherapy for head and neck cancer for at least 6 months were enrolled. The presence of xerostomia, hyposalivation, oral candidiasis, and type of oral yeasts were correlated with post-radiotherapy period. A control group, age and gender matched, was used for comparisons. The Pearson's Chi-square or Fischer's exact test was used at a significance level of 5%. RESULTS: The mean post-radiotherapy period was 32 months. The oral complications found were xerostomia (45/55, [81.8%]), hyposalivation (44/55 [80%]) and oral candidiasis (15/55 [27.2%]). Xerostomia and hyposalivation was statistically higher in the study group when compared to the control group (P < 0.05). The presence of yeast occurred in 39 (70.9%) of the patients in the study group, and Candida albicans was the most prevalent etiological agent in 25 (64.1%) of those patients (P < 0.05). CONCLUSIONS: Xerostomia and hyposalivation were the more prevalent late oral complications related to radiotherapy. Oral candidiasis was also observed, although its prevalence was lower. The need for long-term dental follow-up of patients who underwent radiotherapy of the head and neck cancer is mandatory.

Behaviour and Prevention of 5'Fluorouracil and Doxorubicin-induced Oral Mucositis in Immunocompetent Patients with Solid Tumors: A Randomised Trial.

PURPOSE: This study evaluated the efficacy of four methods to prevent chemotherapy-induced oral mucositis (OM) in patients with solid tumors (ST). In addition, the behaviour of OM was investigated in these oncological patients. MATERIALS AND METHODS: Forty-eight patients, aged 27-84, were randomly allocated to different groups from the first day of chemotherapy (CT), in the following sequence: group 1: intensive oral care programme (IOCP); group 2: 0.12% chlorhexidine mouthrinse; group 3: 0.03% triclosan mouthrinse; group 4: low-level laser therapy (LLLT). Oral mucositis was evaluated on the 7th and 14th days by means of the Oral Mucositis Assessment Scale (OMAS). RESULTS: Thirty-one (64.5%) patients developed OM in the first cycle of CT and the pain was significantly associated with OM severity (p < 0.0001). The statistically significantly worst OMAS score was found for the lips and buccal mucosa (p < 0.0001). Despite a lack of statistical significance, IOCP and LLLT notably demonstrated potential effects to prevent OM in patients who presented with only oral erythema (75%) and lower peak of severity during the follow up, respectively. CONCLUSIONS: Improved oral care awareness is needed in patients undergoing 5'fluorouracil and doxorubicin, mainly to avoid pain caused by oral mucositis. Oral mucositis was more prevalent and aggressive in oral sites exposed to chronic trauma. The IOCP and LLLT approaches showed positive results to prevent oral mucositis and should be further investigated in similar and larger samples.

Envolvimento esportivo e escolar: percepções de alunos-atletas do programa "Basquetebol Para Todos" / Sporting and scholar involvement: perceptions of student-athletes from "Basquetebol Para Todos" program

O objetivo deste estudo quantitativo e descritivo foi analisar o envolvimento esportivo e escolar sob a perspectiva de alunos-atletas do Programa Basquetebol Para Todos. A coleta das informações foi realizada com 80 alunos-atletas por meio de questionário. Os dados foram analisados por intermédio de recursos estatísticos descritivos (frequência simples e percentual) e inferenciais (teste Quiquadrado ou teste Exato de Fisher), com auxílio do software SPSS (versão 21). Na percepção dos alunosatletas, o envolvimento esportivo em termos competitivos não modifica o tempo dedicado aos estudos, bem como as demandas escolares não alteram a presença nos treinos, sugerindo que quanto maior o tempo destinado aos treinos esportivos, maior o tempo dedicado aos estudos extracurriculares. Além disso, constatou-se a predominância de comunicação entre pais e treinadores com relação ao desempenho esportivo e escolar dos alunos-atletas, além de ambos incentivarem jogadores e filhos a se tornarem atletas de alto rendimento. Relativamente às estratégias de estudos fora da sala de aula, evidenciou-se que as crianças preferem estudar individualmente e com antecedência para as atividades escolares. Os principais benefícios percebidos para os estudos, advindos do envolvimento esportivo são a concentração, o compromisso e a redução do estresse, enquanto as influências negativas não foram destacadas. Conclui-se que a produção de evidências a este respeito auxiliará na participação em práticas esportivas articuladas com o desenvolvimento integral da criança, inclusive a escolar, com o intuito de disponibilizar informações para pais e treinadores sobre o nível de cobrança por eles implementado em relação ao envolvimento esportivo e escolar na percepção das crianças envolvidas....(AU)

The aim of this quantitative and descriptive study was to analyze the sporting and scholar involvement from the perspective of student-athletes from Basquetebol para Todos" program. Data collection was performed with 80 student-athletes through questionnaire. The data obtained were analyzed descriptively (simple frequency and percentage) and inferentialy (Chi-square test or Fisher's exact test) using SPSS software (version 21), adopting a significance level of 5%. In the perception of studentathletes, the sporting involvement in competitive way does not change the time devoted to studies, and school demands do not change their presence in the training sessions, suggesting that the more time is devoted to sports training, the greater is the time devoted to extracurricular studies. In addition, there was predominance of good communication between parents / guardians and coaches regarding athletic and academic performance of student-athletes, and both encourage players and children to become high performance athletes. With regard to strategies for education outside of the classroom, we found that the children prefer to study individually and in advance for school activities. The main perceived benefits for the studies, arising from sports involvement, were the concentration, commitment, and stress reduction, while the negative influences were not highlighted. We conclude that the production of evidence in this regard will assist in terms of sports practices' participation articulated with the integral development of the child, including the scholar, in order to provide information to parents /guardians and coaches on the charging level implemented by them related to sporting and scholar involvement in the perception of the children involved....(AU)

Spontaneous Resolution of a Central Giant Cell Granuloma in a Child After an Incisional Biopsy: A Five-year Follow-up.

A central giant cell granuloma (CGCG) is typically regarded as a benign lesion with osteoclastic activity. Treatment often involves surgical procedures that may cause deformities; however, minimally invasive approaches have been suggested for treating pediatric patients. We report a case of CGCG of the mandible in a 13-year-old boy who presented with a well-defined radiolucent area in the anterior mandible that was initially detected in a radiographic examination for orthodontic purposes. An incisional biopsy was performed and diagnosed histologically as a CGCG. The patient underwent clinical and radiographic follow-up only after the biopsy, eventually showing signs of bone healing. Five years later, complete resolution of the lesion was observed radiographically. Considering this optimal outcome, similar cases of CGCG should be carefully analyzed for appropriateness of this conservative approach.