Sensitive and simultaneous determination of nine anticoagulant rodenticides in human blood by UPLC-MS-MS with phospholipid removal pretreatment.

A sensitive and rapid method for the simultaneous determination of nine anticoagulant rodenticides (ARs) in human blood is reported herein. The method involves phospholipid removal pretreatment for reduced matrix effect (ME) and detection with ultra-performance liquid chromatography coupled with tandem mass spectrometry. Satisfactory recoveries were achieved ranging from 80.6% to 113.1% for the nine analytes, with the intra-day relative standard deviations (RSDs) in the range of 3.4-7.9% and inter-day RSDs in the range of 4.1-8.3%, indicating good precision. Linear relationships with correlation coefficients above 0.998 (n = 6) were found in the range of 1-2,000 ng/mL. High sensitivity was achieved with limits of detection ranging from 0.02 to 0.3. The application of phospholipid removal step significantly optimized the ME, and the reduction of ME ranged from 6.1% to 15.5%. This method was successfully applied to the determination of ARs for blood samples from real forensic cases. These results prove that this method is reliable for rapid forensic and clinical diagnosis. The removal capabilities for five representative phospholipids that are abundant in blood were evaluated individually with Phree™ phospholipid removal plates. While significant capabilities for phospholipid removal were confirmed, the results showed that the removal capability for certain phospholipid could be improved.

Gingival bleeding, a possible "serious" adverse drug reaction: An observational study in the French PharmacoVigilance Database.

INTRODUCTION: Antithrombotic drugs are known to increase the risk of gingival bleeding because they affect coagulation. However, other drugs could also be involved in gingival bleeding. AIM: We performed a pharmacoepidemiological study to identify the drugs most frequently "suspected" in the occurrence of gingival bleeding. MATERIAL AND METHODS: We selected reports of "gingival bleeding" from 1 January 1985 to 30 September 2014 in the French PharmacoVigilance Database. RESULTS: Among 523,808 reports of adverse drug reactions, we identified 454 reports of gingival bleeding (0.09%). Most of them were "serious" (58.4%) and occurred in females (54.6%). The frequency of gingival bleeding increased with age. The most frequently "suspected" drugs were antithrombotics (67.8%), particularly fluindione. Other drugs frequently involved were furosemide followed by paracetamol, amiodarone, amoxicillin, paroxetine, ketoprofen, zolpidem, enalapril and ramipril. Thirty-nine reports involved a drug-drug interaction with antithrombotics, mainly with anti-infectives. CONCLUSION: Gingival bleeding can be an adverse drug reaction, often "serious" and rarely fatal. Patients older than 50 years and women are particularly at risk. Among drugs known to increase the risk of gingival bleeding, the most frequently involved were fluindione, furosemide, paracetamol, amiodarone, amoxicillin, paroxetine or ketoprofen. We also identified signal for drugs not usually known to be involved in bleeding, like zolpidem, enalapril or ramipril.

Telangiectasia and Pulmonary Arterial Hypertension Following Treatment With Trastuzumab Emtansine: A Case Report.

Trastuzumab emtansine (T-DM1) is a Food and Drug Administration-approved novel agent for the treatment of HER-2 positive advanced breast cancer. We report a case of pulmonary arterial hypertension (PAH) that we attribute to the use of T-DM1. A 43-year-old woman with stage IV breast cancer presented with dyspnea on exertion. After excluding other secondary causes of pulmonary hypertension, a diagnosis of moderately severe PAH was made based on right heart catheterization. History revealed that the patient had been on T-DM1 before presentation. During T-DM1 treatment, the patient experienced hereditary hemorrhagic telangiectasia-like symptoms consisting of spider angiomata-skin lesions, epistaxis, and hematochezia, which resolved with discontinuation of T-DM1. Temporal associations of T-DM1 use with the development of PAH in the patient, and the reported association between hereditary hemorrhagic telangiectasia and PAH via genetic linkage, led us to suspect T-DM1 as the cause of PAH.

Plasma Cell Gingivitis: An Occasional Case Report.

Plasma cell gingivitis, an infrequently observed oral condition, has been clinically characterized by diffuse gingival enlargement, erythema and sometimes desquamation. These lesions are usually asymptomatic, but invariably the patient will complain of a burning sensation in the gingiva and bleeding from the mouth. The diagnosis requires hematological screening in addition to clinical and histopathological examinations. This case report outlines one such case of plasma cell gingivitis in a 15-year-old female caused by use of an herbal, homemade toothpowder. The case presented here highlights the adverse effects and irrational use of herbal agents in dentifrices. At the same time, it emphasizes the need for comprehensive history taking, careful clinical examination and appropriate diagnostic tests in order to arrive at a definitive diagnosis and treatment plan for gingival conditions that are refractory to conventional therapy and to exclude certain malignancies and oral manifestations of systemic diseases.

[Paroxysmal nocturnal hemoglobinuria and intestinal ischemia: a very wide choice]. / L'ischémie intestinale au cours de l'hémoglobinurie paroxystique nocturne: l'embarras du choix.

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare hematologic disorder that can exceptionally be complicated by splanchnic thrombosis and intestinal necrosis. The discovery of multiple and dispersed distal ischemia of the small bowel is a real problem because the therapeutic approach depends on the range and the number of the segments to resect and also on the risk of recurrence of new peri-operative ischemic lesions. We report the case of a patient suffering from PNH, operated with the diagnosis of mesenteric infarction. We discovered multiple distal ischemic lesions of the gut extending from the first duodenum to the penultimate loop without perforation. Resection was then ruled out and curative anticoagulation was initiated. Outcome was favorable with restitution ad integrum of the digestive lesions without progression to secondary stenosis. Discovery of distal ischemic lesions without perforation in patients with PNH does not necessarily require resection. Curative anticoagulation can avoid surgery that may be insufficient.

The impact of Prasugrel, a new anti-platelet agent, on dental care of patients.

With increasing usage of Prasugrel (Effient), a new and highly efficient antiplatelet agent, in the management of cardiovascular events, the potential for bleeding complications has also increased. This is further compounded by the lack of a reversal agent, therefore poses a problem for clinicians engaged in oral invasive procedures. A case in which a patient taking daily Prasugrel suffered significantly prolonged bleeding following dental cleaning is reported. Local measures were used to achieve hemostasis. It is prudent to consult the prescribing physician about the risk of Prasugrel-induced bleeding, the potential for recurrence of cardiovascular events with disruption of medication, and the appropriate management strategy in advance of planned oral invasive procedures. Local measures are the first line of approach for management of hemostatic complications associated with Prasugrel, and patients should be referred to specialized centers if local approach fails. As more data become available, further evidence-based guidelines can be established.

Evaluation of gingival inflammation in patients using ovulation induction drugs before and after scaling.

OBJECTIVES: To determine and correlate the effect of clomiphene citrate, Letrozole in women undergoing infertility treatment on the gingival inflammatory status. MATERIALS AND METHODS: The present study is a randomized controlled clinical trial which consisted of 26 women using CC for three menstrual cycles, 26 women using CC for more than three cycles, 26 women using Letrozole. All subjects were clinically examined for plaque levels (Plaque Index), gingival inflammation, bleeding on probing (Gingival Index, Sulcus Bleeding Index). Scaling was done to all patients and all periodontal parameters were reassessed 1 month after scaling. The results were compared with a control group of 26 women matched for age, educational status and professional level, and oral habits and who had never used ovulation drugs. RESULTS: Baseline scores of all the test groups showed higher amount of plaque levels and inflammation compared to control. (p < 0.05). After scaling a significant reduction in inflammation was observed in all the test groups along with the control group (p < 0.0001), but women using the drugs showed persistence of inflammation compared to control (p < 0.01). CONCLUSION: It can be concluded from the present study that the presence of elevated levels of hormones due to the effect of ovulation induction drugs may be the reason for the gingival inflammation in test groups.

Drug-induced gingival overgrowth: a case report.

A variety of systemic drugs can lead to adverse effects in the oral environment. This article reports the case of a 61-year-old man who had a severe drug-induced gingival overgrowth (DIGO) caused by nifedipine. DIGO is relevant due to severe gingival enlargement, which causes disfigurement and blocks physiological and social functions such as mastication and speaking. Management of DIGO is always a challenge due to the patient's systemic condition. This article shows, step-by-step, how the treatment was executed and how the DIGO was reversed.

Gingival bleeding and jaw bone necrosis in patients with metastatic renal cell carcinoma receiving sunitinib: report of 2 cases with clinical implications.

There is emerging evidence that oral mucositis/stomatitis is a common adverse effect of sunitininb antiangiogenic therapy in patients with metastatic renal cell carcinoma (mRCC). In addition, a case of sunitinib-related jaw osteonecrosis was recently described. We report on 2 patients with mRCC treated with sunitinib. The first patient, a 19-year-old woman, treated with cisplatin and sunitinib, presented with oral pain, malodor, spontaneous and continuous gingival bleeding, and painful necrotic ulcerations clinically resembling necrotizing ulcerative gingivitis (NUG). Suntinib-related stomatitis and bleeding were considered cumulative to NUG symptoms. The second patient, a 64-year-old woman, treated with sunitinib only, complained of mandibular pain. Sunitinib-related jaw osteonecrosis was diagnosed. Gingival bleeding and soft tissue necrosis, as well as jaw osteonecrosis may develop as adverse events of sunitinib use. Antiangiogenic therapies are increasingly used in the treatment of cancers. The presented cases are aimed to alert health care professionals on adverse oral events.

Oral complications associated with D-penicillamine treatment for Wilson disease: a clinicopathologic report.

BACKGROUND: Wilson disease (WD) is a hereditary disease inhibiting copper release from the liver. Multi-organ manifestations involve the liver, nervous system, kidneys, eyes, heart, and skin. Elastic fiber damage is a complication of the most frequently used medication in the treatment of WD D-penicillamine (D-PCA). These changes have very rarely been described in the oral cavity. The article describes oral complications associated with WD and its treatment by D-PCA. METHODS: Clinical, radiographic, and microscopic evaluation was done on two WD female patients (aged 28 and 53), treated by D-PCA, with clinical and pathological evidence for oral drug-related complications. RESULTS: The lesions included multiple small red papules of the lips, gingival enlargement, early onset periodontitis, and repeated oral candidiasis. Biopsies of oral mucosa (gingiva, buccal) exhibited in one case granulomatous inflammation, and in both cases, thick irregular clumps of tortuous, red-staining abnormal elastic fibers. The red lip papules resemble elastosis perforans serpiginosa (EPS). Similar lesions have been described in the skin, but never before in association with oral or perioral tissue. In addition to the oral lesions, one of the patients developed general intolerance to the drug and was switched to trientine hydrochloride. CONCLUSIONS: WD patients and others treated by D-PCA may develop oral and perioral complications, in some cases exhibiting features of damaged elastic fibers in the mucosa and periodontal apparatus. It is possible that this damage may be one of the factors responsible for poor periodontal health in WD patients. Recognition of the lesions can lead to replacement of the affecting therapeutic agent.

Non-surgical treatment of gingival overgrowth induced by nifedipine: a case report on an elderly patient.

Drug-induced gingival overgrowth (DIGO) is a significant problem for periodontologists and this side effect is frequently associated with three particular drugs: phenytoin, cyclosporin A and nifedipine. A case report of gingival overgrowth induced by nifedipine in an elderly patient treated with non-surgical periodontal therapy is described. A 75-year-old male with generalised gingival overgrowth reported the problem of oral malodour and significant gingival bleeding. The medical history revealed a controlled hypertensive state and Cerebral Vascular Accident (CVA) 3 years prior to consultation. The diagnosis was gingival overgrowth associated with nifedipine, no other risk factors being identified. The patient had been taking nifedipine for 18 months, but after the consultation with the patient's doctor, nifedipine was suspended, as the hypertension was controlled. Treatment consisted of meticulous oral hygiene instruction, scaling, root surface instrumentation and prophylaxis. Six months after the first intervention, clinical parameters revealed a significant improvement with a considerable reduction in gingival overgrowth, demonstrating the effect of non-surgical periodontal therapy in severe cases of gingival overgrowth. Non-surgical treatment of DIGO is a far less invasive technique than surgical approaches and has demonstrated an impressively positive treatment response. It should therefore be considered as a first treatment option for DIGO.

A clinical evaluation of two in-office bleaching regimens with and without tray bleaching.

This study evaluated the degree of color change of teeth, the rebound effect and the sensitivities of teeth and gingiva associated with the use of an in-office bleaching agent followed by an at-home bleaching agent to lighten stained teeth in an in vivo study. Thirty-seven subjects who met the Inclusion/Exclusion criteria were divided into two cells. Twenty-five subjects received three 15-minute in-office bleaching treatments in succession with 36% hydrogen peroxide (HP) on the maxillary anterior teeth, followed by at-home overnight bleaching with 15% carbamide peroxide (CP) for seven days on one side of the dental arch. Twelve other subjects received a 40-minute in-office bleaching treatment on their maxillary anterior teeth, followed by at-home overnight bleaching for seven days on one side of the dental arch with the same product. The cells of teeth on the other side of the dental arch received the same in-office treatment but were not bleached overnight for seven days. Color was subjectively evaluated using the Vitapan Classical Shade Guide and was objectively evaluated using the Chroma Meter at the baseline appointment, immediately after in-office bleaching and at 4, 7 and 14 days and 3 months after the in-office treatment. For two weeks, the subjects completed sensitivity evaluations of gingival tissues and hard tooth tissues. The cells that did not receive the at-home bleaching had significantly less color change than the cells that received at-home bleaching. The cell that was bleached for 40 minutes and received the at-home treatment had significantly less overall change (deltaE) at 14 days and 3 months than the cell that received three 15-minute treatments with the at-home treatment. Throughout the study, the subjects in the three 15-minute treatment cells had less gingival and tooth sensitivity than the other cells.

Effectiveness of nightguard vital bleaching with 10% carbamide peroxide -- a clinical study.

OBJECTIVE: To use the criteria set by the American Dental Association to evaluate the effectiveness of nightguard vital bleaching with 10% carbamide peroxide through a controlled randomized clinical trial. MATERIALS AND METHODS: Fifty volunteers allocated to either an experimental group(Opalescence PF 10%; OPA) or a control group (placebo; PLA) used a gel for 21 days. Observations of tooth colour were recorded at baseline, immediately after 3 weeks of use(day 21), and 30 days (day 30) and 6 months (day 180) after the treatment was finished. Colour was evaluated with the Vitapan classical shade guide and from the volunteers' degree of satisfaction. Tooth sensitivity and gingival bleeding were also assessed. RESULTS: The median increase in the lightness of the teeth in the OPA group was 3 units,based on the value-ordered Vitapan shade guide. This improvement in lightness was maintained for 6 months in 88% of this group. In the PLA group, 8% had a 2-unit reduction in tooth colour at day 21. Tooth sensitivity occurred in the OPA (36%) and PLA (8%)groups. Gingival bleeding was not associated with gel use. Volunteers' satisfaction was 92% for the OPA and 8% for the PLA group. CONCLUSIONS: With the protocol used, nightguard vital bleaching was an effective technique that had minimal and transient side effects that disappeared after treatment without causing sequelae or complications.

Nickel sensitivity: a case report.

In dentistry, three "non-precious" alloy groups predominate: chromium-cobalt, nickel-chromium, and nickel-chromiumberyllium. These alloys have little or no precious metals, but exhibit low flexibility and achieve high porcelain-to-metal bond strengths when handled properly. The most common of the "non-precious" metal alloys utilize nickel; unfortunately, nickel is the most common of all potential metal contact allergens. This article describes a case involving a patient with a sensitivity reaction to the metal component of a ceramo-metal crown and the procedure that was used to rectify the problem.

Chemotherapy-induced oral complications in leukemic patients.

UNLABELLED: The adverse effects of chemotherapy frequently involve the oral cavity, but the severity of oral complications caused by different chemotherapy protocols is unknown. OBJECTIVE: To compare the frequency of oral complications in patients with acute lymphoblastic leukemia treated with the GBTLI-93 and BFM protocols. PATIENTS AND METHODS: Twenty patients ranging in age from 2 to 13 years were submitted to visual and tactile examination of the teeth, periodontium and soft tissues on the day of admission and over the 3 weeks following the first phase of chemotherapy. RESULTS: No significant difference in the proportion of patients with complications was observed between the two protocols over the 3 weeks. Complications were more frequent immediately after administration of the chemotherapeutic agents, with a gradual decline over the following 3 weeks. CONCLUSIONS: Oral complications occur in patients with acute lymphoblastic leukemia irrespective of the chemotherapy protocol used for treatment, with a higher frequency being observed in the first week after the beginning of antineoplastic therapy.

Debridement could be a solution to promote healing of established oral mucositis in children.

AIM: The aim of the study was to present a novel approach to promote healing of established oral mucositis and to alleviate symptom clusters in a group of children who were on induction chemotherapy. STUDY DESIGN: A clinical prospective study. METHODS: Children (40) diagnosed with Grade 3 or 4 oral mucositis were randomly assigned into two groups: In Group I (n=20), accumulated debris on ulcerations was removed (debridement); In Group II (n=20), subjects had no debridement. The condition of oral lesions, speech, lips, teeth, saliva, gingiva, and swallowing ability were examined 3 x week during the study. All subjects received the same oral care regimen. They were well balanced in respect of age, the type of antineoplastic treatment, and the number. RESULTS: Debridement promoted resolution and decreased the severity of oral mucositis significantly. Thus, the subjects had less oral discomfort, pain, and nutritional difficulties. STATISTICS: The data were entered in the SPSS 13.0 program, and the tests used were Kolmogorov-Smirnov, Shapiro-Wilk, Mann-Whitney, and Spearman's correlation coefficient with a 5% significance level. CONCLUSION: Well-controlled, prospective clinical studies related to the management of established oral mucositis will lead to the development of potential interventions and improved patient care.