bluuebunny/crossref_metadata_2025 huggingface dataset:
Maiorchino cheese: physicochemical, hygienic and safety characteristics
Authors: Conte Francesca , Ravidà Andrea , Mandanici Alessandro , Ferrantelli Vincenzo , Chetta Michele , Verzera Antonella
Published: June 2015

This study assessed the physical, chemical, and microbiological characteristics of traditional Maiorchino cheese (Italy) made from raw ewe’s milk or from a mixture with goat’s milk. Cheese samples from the same batch were analyzed after 20 days and 6, 8, 12, 17 and 24 months of ripening. A decrease in moisture level lead to progressive total solids concentration (fat, total nitrogen, total solids and chloride) during ripening. Aw values decreased from 0.97 (day 20) to 0.85 (month 24), while pH increased from 4.99 to 5.41 (6 months) followed a by reduction until 4.85 (month 24). In samples analysed 20 days after cheesemaking, aerobic mesophilic count was 1.8•107 CFU/g, Enterobacteriaceae were 2.7•106 CFU/g, Staphylococcus spp. were 1.8•104 CFU/g, and yeasts 4.5•105 CFU/g. Sulphite reducing bacteria were not found. Lactic bacteria count at 30°C (LAB30) and 42°C (LAB42) was about 108 CFU/g (day 20); LAB30 reduced until month 8; LAB 42 reduced until month 12; both were not detectable at months 17 and 24. Cheese-making process does not consider commercial starter cultures and LAB group is heterogeneous because of its natural microflora. Yeasts were considered as typical microflora of Maiorchino. Volatile compounds were examined at 6, 12 and 24 months of ripening; 54 components were identified. Statistical analysis showed that the seasoning period of 12 months was the best for Maiorchino flavour attributes. The characterisation of Maiorchino traditional cheese may be considered as significant for this old traditional product, with the aim of obtaining the PDO certification.
Detection of pathogenic Yersinia enterocolitica in slaughtered pigs by cultural methods and real-time polymerase chain reaction
Authors: Mazzette Rina , Fois Federica , Consolati Simonetta Gianna , Salza Sara , Tedde Tiziana , Soro Paolo , Collu Carlo , Ladu Daniela , Virgilio Sebastiano , Piras Francesca
Published: June 2015

Healthy pigs carrying pathogenic to human Yersinia enterocolitica strains are the main source of entry into slaughterhouse, where cross-contamination of carcasses can happen. The aim of this work was to determine Y. enterocolitica prevalence in slaughtered pigs, investigating the presence of carriers in relation to carcass contamination. A total of 132 pig samples (tonsils, mesenteric lymph nodes, colon content, carcass surface) were collected from 4 Sardinian slaughterhouses. All the samples were examined by the ISO 10273:2003 method, and the prevalence was also determined by direct plating on CIN Agar. Moreover, to detect the ail positive Y. enterocolitica strains in enrichment broths and isolates a real-time polymerase chain reaction (PCR) was applied. Y. enterocolitica prevalence was 19% with direct plating and 12% with enrichment methods. Carcass surfaces and tonsils prevalence was 5.30% by direct plating, and 5.3% and 2.2%, respectively, by enrichment method. Tonsil samples showed an average contamination level of 3.2×103 CFU/g, while the mean value on carcass was 8.7×102 CFU/g. An overall prevalence of 9.8% of ail positive Y. enterocolitica broths was detected by RT-PCR, that found a higher prevalence in tonsils (7.5%) with respect to cultural methods, confirming the greater sensitivity of this technique when applied for tonsils and faeces samples. The results show a relatively low pathogenic Y. enterocolitica prevalence in pigs slaughtered in Sardinia. Good hygiene measures should be applied at slaughterhouse in order to prevent the entry of carriers and control carcass contamination.
Omega-3 fatty acid ethyl esters do not improve clopidogrel associated P2Y12 inhibition in stroke patients
Authors: Li Ping , Kamal Haris , Baxter Melissa , Mehta Bijal K.
Published: June 2015

The specific action of omega-3 fatty acid ethyl esters (OFA) in preventing cerebrovascular disease remains unknown, but research has demonstrated multiple possible mechanisms. In addition to altering lipid profiles, OFA may inhibit platelet aggregation. Clopidogrel inhibits platelets via the P2Y12 receptor. OFA may alter clopidogrel-associated platelet-inhibition via a possible combined effect on P2Y12 inhibition. To determine if OFA affects clopidogrel associated P2Y12 platelet receptor inhibition by comparing the percentage of responders in patients with cerebrovascular disease who were taking clopidogrel with or without OFA. We retrospectively reviewed data from adult patients with cerebrovascular disease or cerebral aneurysms and taking clopidogrel, who were seen at a single hospital between March 2010 to September 2011. We included 438 subjects in the study. For the 67 subjects who received loading doses of both clopidogrel and OFA, 71.6% had a P2Y12 inhibition response more than 20%, which is considered a positive response. For the 55 subjects who received just clopidogrel load, 67.2% of subjects were responders. There were 70.4% responders in the 274 subjects who were taking 75 mg of clopidogrel alone at home, and 73.8% responders in the 42 subjects who were taking both clopidogrel and OFA at home. However, these percentage differences were not statistically significant. This study did not find additional P2Y12 platelet inhibition when patients were given OFA, either given as a loading dose or taking it daily.
Posterior reversible encephalopathy syndrome and acute post-streptococcal glomerulonephritis mimicking breakthrough seizures
Authors: Abdool Kamille , Ramcharan Kanterpersad , Bhagwandass Neal , Persad Navindra , Temull Vasant , Seegobin Karan , Mike Cassie
Published: June 2015

We report the case of a 14-year-old boy with a past history of primary generalized seizures, who had been seizure-free for 2 years on sodium valproate and presented with generalized tonic clonic seizures suggestive of breakthrough seizures. Examination revealed hypertension, impetiginous lesions of the lower limbs, microscopic hematuria, elevated antistreptolysin O titre and low complement levels consistent with acute post-streptococcal glomerulonephritis. Cranial magnetic resonance imaging (MRI) demonstrated changes consistent with posterior reversible encephalopathy syndrome. Hypertension was controlled with intravenous nitroglycerin followed by oral captopril and amlodipine. Brain MRI changes returned normal within 2 weeks. The nephritis went in to remission within 2 months and after 8 months the patient has been seizure free again. Posterior reversible encephalopathy syndrome appeared to have neither short nor intermediate effect on seizure control in this patient. The relationship between posterior reversible encephalopathy syndrome and seizures is reviewed.
Coping Strategies and Locus of Control in Childhood Leukemia: A Multi-Center Research
Authors: Polizzi Concetta , Fontana Valentina , Perricone Giovanna , D'Angelo Paolo , Jankovic Momcilo , Taormina Calogero , Nichelli Francesca , Burgio Sofia
Published: June 2015

Acute lymphoblastic leukemia (ALL) is a very distressing experience for children and requires a special effort of adjustment. Therefore, it seems to be crucial to explore coping resources for the experienced risk condition. In this sense, the study focuses on coping strategies and locus of control in children with ALL during the treatment phase, and on their possible relation. The correlation between children and maternal coping strategies is also investigated. The participants involved were an experimental group of 40 children with ALL and their mothers, and 30 healthy children as the control group. The tools used were: the Child Behavioral Style Scale and the Monitor-Blunter Style Scale to assess the coping strategies of children and mothers; the locus of Control Scale for Children to analyze the children’s perception of controlling the events. Both children with ALL and their mothers resorted to monitoring coping strategies with a statistically significant rate of occurrence (children: M=17.8, SD=3.8; mothers: M=10.48, SD=3.4). The data concerning the locus of control show this tendency towards internal causes (M=53.1, SD=4.7). There were statistically significant correlations between monitoring coping strategies and external locus of control (r=0.400, P<0.05). The results gained from the control group are almost equivalent. The outcomes show several interesting resources of the psychological functioning of children as well as of their mothers.
Acute Disseminated Encephalomyelitis After Plasmodium Vivax Infection: Case Report and Review of Literature
Authors: Sidhu Jasmeet , Maheshwari Anu , Gupta Raju , Devgan Veena
Published: June 2015

Acute demyelinating encephalomyelitis (ADEM) usually occurs after viral infections or vaccination. Its occurrence after Plasmodium vivax infection is extremely uncommon. We report the case of an 8-year-old girl who had choreo-athetoid movements and ataxia after recovery from P.vivax infection. Diagnosis of ADEM was made on the basis of magnetic resonance imaging findings. The child responded to corticosteroids with complete neurological recovery.
First-drug treatment failures in 42 Turkish children with idiopathic childhood occipital epilepsies
Authors: Incecik Faruk , Herguner Ozlem M. , Altunbasak Sakir
Published: June 2015

Background: The early and late benign occipital epilepsies of childhood (BOEC) are described as two discrete electro-clinical syndromes, eponymously known as Panayiotopoulos and Gastaut syndromes. The purpose of this study was to identify predictors of failure to respond to the initial antiepileptic drug (AED). Materials and Methods: A total of 42 children with BOEC were enrolled. Predictive factors were analyzed by survival methods. Results: Among the 42, 25 patients (59.5%) were boys and 17 (40.5%) were girls and the mean age at the seizure onset was 7.46 ± 2.65 years (4-14 years). Of the 42 patients, 34 (81.0%) were treated relatively successfully with the first AED treatment, and 8 (19.0%) were not responded initial AED treatment. There was no correlation between response to initial AED treatment and sex, consanguinity, epilepsy history of family, age of seizure onset, frequency of seizures, history of status epilepticus, duration of starting first treatment, findings on electroencephalogram. However, history of febrile seizure and type of BOEC were significantly associated with failure risk. Conclusions: Factors predicting failure to respond to the AED were history of febrile seizure and type of BOEC in children with BOEC.
A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study
Authors: Ramos-Zúñiga Rodrigo , Díaz-Guzmán Laura Rocío , Velasquez Shannen , Macías-Ornelas Ana Magdalena , Rodríguez-Vázquez Martín
Published: June 2015

Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma); and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.
Methylphenidate use among medical students at Ben-Gurion University of the Negev
Authors: Cohen Yael Givon , Segev Renana Wilkof , Shlafman Nurit , Novack Victor , Ifergane Gal
Published: June 2015

Introduction: Methylphenidate is a psychotropic agent commonly used for the treatment of attention deficit disorder with or without hyperactivity and narcolepsy in children and adults. The awareness to attention deficit disorder as well as the non-medical use of methylphenidate for cognitive enhancement has increased during the past years. Objectives: To evaluate the medical and non-medical use of methylphenidate among medical students in the Ben-Gurion University of the Negev. Materials and Methods: Medical students were asked to report methylphenidate use, symptoms and diagnosis of attention deficit disorder using a structured questionnaire. Results: A total of 229 students participated in the study, out of which 105 (45.9%) were in the pre-clinical years of medical school. Twenty-two students (9.6%) were previously diagnosed with attention deficit disorder. Lifelong use of methylphenidate was reported by 39 (17%) students, while 31 students (13.5%) reported using methylphenidate during the preceding 12 month. In the beginning of medical school, only 7% of the students used methylphenidate, most of them began using it during pre-clinical academic years. Discussion: High rates of attention deficit disorder compared to the general population were reported by medical students. The rate of methylphenidate use is similar to recent report from a US medical school, and is considerably higher than in college students population. Conclusions: Many medical students are using methylphenidate without a medical indication. Further study is needed to evaluate the effect of methylphenidate on academic performance of healthy adults.
Disorders of the lower cranial nerves
Authors: Finsterer Josef , Grisold Wolfgang
Published: June 2015

Lesions of the lower cranial nerves (LCN) are due to numerous causes, which need to be differentiated to optimize management and outcome. This review aims at summarizing and discussing diseases affecting LCN. Review of publications dealing with disorders of the LCN in humans. Affection of multiple LCN is much more frequent than the affection of a single LCN. LCN may be affected solely or together with more proximal cranial nerves, with central nervous system disease, or with nonneurological disorders. LCN lesions have to be suspected if there are typical symptoms or signs attributable to a LCN. Causes of LCN lesions can be classified as genetic, vascular, traumatic, iatrogenic, infectious, immunologic, metabolic, nutritional, degenerative, or neoplastic. Treatment of LCN lesions depends on the underlying cause. An effective treatment is available in the majority of the cases, but a prerequisite for complete recovery is the prompt and correct diagnosis. LCN lesions need to be considered in case of disturbed speech, swallowing, coughing, deglutition, sensory functions, taste, or autonomic functions, neuralgic pain, dysphagia, head, pharyngeal, or neck pain, cardiac or gastrointestinal compromise, or weakness of the trapezius, sternocleidomastoid, or the tongue muscles. To correctly assess manifestations of LCN lesions, precise knowledge of the anatomy and physiology of the area is required.
Bilateral optic nerve infarction in rhino-cerebral mucormycosis: A rare magnetic resonance imaging finding
Authors: Ghuman Mandeep Singh , Kaur Shabdeep , Bhandal Samarjit Kaur , Ahluwalia Archana , Saggar Kavita
Published: June 2015

Mucormycosis is an emerging disease in diabetes and immunocompromised patients. Rhino-orbito-cerebral mucormycosis is one of the common forms of the disease. Mucormycosis leading to ischemic optic neuropathy is a rare complication. The role of magnetic resonance imaging (MRI) in the diagnosis of ischemic optic neuropathy is limited and uncommonly reported. We report an unusual case of mucormycosis in which MRI revealed bilateral optic nerve infarction, in addition to perineural extension of the fungus along the trigeminal nerve, another uncommon imaging finding.
Solitary extramedullary plasmacytoma of thoracic epidural space presenting with dorsal compressive myelopathy: A case report and review of literature
Authors: Kumar Amandeep , Satyarthee Guru Dutt , Sable Mukund , Suri Vaishali , Sharma Bhawani S.
Published: June 2015

Plasma Cell neoplasms result from monoclonal proliferation of plasma cells. Solitary extramedullary plasmacytomas (SEMPs) are rare and constitute 5% of all plasma cell disorders. SEMPs most commonly involve upper aerodigestive tract. Isolated spinal epidural space involvement by SEMPs is extremely rare and to best of our knowledge only 7 such cases have been reported previously in available English literature. We hereby present a rare case of thoracic epidural SEMP in a 32-year-old female who presented with thoracic compressive myelopathy and discuss the pertinent literature.
Kissing naevus arising from neural crest cells presenting as upper and the lower lid mass
Authors: Rajput Gian Chand , Mahajan Deepti , Chaudhary Kulbhushan Prakash , Deewana V.
Published: June 2015

A kissing nevus is a type of congenital compound nevus that affects equal portions of the upper and lower eyelid, and it extends to the lid margins. Congenital divided nevi of the eyelids are a rare melanocytic lesion. Only 30 patients are reported in the literature. We report a 40-year-old female of rural background who presented with a large painless enlarging pigmented mass, involving both upper and lower left eyelid since the past 20 years. Complete excision of the lesion was done, and the mass sent for histopathology, which revealed a compound nevus involving both lids. Surgery removed the obstruction, which had caused decreased visual acuity and had altered the cosmetic appearance of the patient. Lesions on the upper lid cause a mechanical ptosis, covers the visual axis, which causes obstruction in vision and is cosmetically unacceptable. There is a definite risk of malignant change in the nevus giving rise to malignant melanoma, and hence they should be removed as early as possible to give better functional and cosmetic results.
Validation of the Tamil version of short form Geriatric Depression Scale-15
Authors: Sarkar Sonali , Kattimani Shivananand , Roy Gautam , Premarajan K. C. , Sarkar Siddharth
Published: June 2015

Background: Local language screening instruments can be helpful in early assessment of depression in the elderly in the community and primary care population. This study describes the validation of a Tamil version of Geriatric Depression Scale (short form 15 [GDS-15] item) in a rural population. Materials and Methods: A Tamil version of GDS-15 was developed using standardized procedures. The questionnaire was applied in a sample of elderly (aged 60 years and above) from a village in South India. All the participants were also assessed for depression by a clinical interview by a psychiatrist. Results: A total of 242 participants were enrolled, 64.9% of them being females. The mean score on GDS-15 was 7.4 (±3.4), while the point prevalence of depression was 6.2% by clinical interview. The area under the receiver-operator curve was 0.659. The optimal cut-off for the GDS in this sample was found at 7/8 with sensitivity and specificity being 80% and 47.6%, respectively. Conclusion: The Tamil version of GDS-15 can be a useful screening instrument for assessment of depression in the elderly population.
Psychiatry at undergraduate level in India: What is needed?
Authors: Kavoor Anjana Rao , Mitra Sayantanava
Published: June 2015

Present day health-care philosophy strongly favors an increased attention to mental health related issues. However, the lack of an adequate number of trained specialists in India in this field makes it imperative that the burden is shared by general practitioners at large. But our current medical education system may not be equipped enough to prepare them for the task.
Bivariant cyclic cohomology and Connes’ bilinear pairings in noncommutative motives
Authors: Tabuada Gonçalo
Published: June 2015

In this article we further the study of noncommutative motives. We prove that the bivariant cohomology and the bivariant Chern character of any additive invariant

E

become representable in the category of noncommutative motives. This applies in particular to bivariant cyclic cohomology and its variants. When

E

is moreover symmetric monoidal we prove that the associated Chern character is multiplicative and characterize it by a precise universal property. In the particular case of bivariant cyclic cohomology the associated Chern character becomes the universal lift of the Dennis trace map. Then, we prove that under the above representability result, the composition operation in the category of noncommutative motives identifies with Connes’ bilinear pairings. As an application, we obtain a simple model, given by Karoubi’s infinite matrices, for the (de)suspension of these bivariant cohomology theories.
Antibacterial Potential of 2.5% Sodium Hypochlorite in Distinct Irrigation Protocols on Enterococcus faecalis Biofilm
Authors: de Araújo Estrela Cyntia Rodrigues , de Alencar Ana Helena Gonçalves , Estrela Carlos , Alves Denise Ramos Silveira , Cunha Rodrigo Sanches , da Silveira Bueno Carlos Eduardo , Santos Tatiane Oliveira dos
Published: June 2015

Objective

The aim of this study was to evaluate the effect of irrigation methods on antibacterial potential of 2.5% NaOCl on Enterococcus faecalis biofilm.

Materials and methods

Enterococcus faecalis biofilms were prepared during 60 days on 48 human root canals and randomized into control and experimental groups using positive and negative pressure irrigation. Bacterial growth was analyzed using turbidity of culture medium followed by UV spectrophotometry, and scanning electron microscopy (SEM) analyses were performed. Mean and standard deviations were used for evaluate the mean optical densities associated to the number of bacteria present culture, and Scheirer-Ray-Hare (an extension of the Kruskal-Wallis test) and Tamhane test to analyze the SEM images in the groups and thirds. Significance was set at 5%.

Results

Enterococcus faecalis was still present after root canal cleaning regardless of irrigation methods or bacterial identification methods.

Conclusion

Positive and negative pressure irrigation protocols using 2.5% NaOCl show a similar capacity to reduce E. faecalis in infected root canals.

How to cite this article

Alves DRS, Cunha RS, da Silveira Bueno CE, de Alencar AHG, de Araújo Estrela CR, dos Santos TO, Estrela C. Antibacterial Potential of 2.5% Sodium Hypochlorite in Distinct Irrigation Protocols on Enterococcus faecalis Biofilm. J Contemp Dent Pract 2015;16(5):340-346.
Correlation of Dental and Skeletal Malocclusions in Sagittal Plane among Saudi Orthodontic Patients
Authors: Al-Hamlan Nasir , Al-Eissa Balsam , Al-Hiyasat Ahmad S , Albalawi Farraj S , Ahmed Anwar E
Published: June 2015

Aim

Whether or not the dental relationship correlates with skeletal relationship in the sagittal plane is an area of interest for orthodontic diagnosis and treatment planning. Thus, the aim of this study was to investigate the correlation of the dental malocclusion and the skeletal malocclusion in the sagittal plane among Saudi orthodontic patients.

Materials and methods

Orthodontic dental casts and cephalometric radiographs of 124 patients were investigated and analyzed. The dental casts were classified in relation to the molar relationship according to Angle's classification and to the incisal relationship according to the British Standards Institution (BSI) classification. The sagittal relation in the cephalometric radiographs was analyzed according to ANB angle and WITS appraisal.

Results

The results show that the incisal relation had a very high significant association with WITS appraisal (p = 0.0045), whereas with ANB, the association was marginally significant (p =0.0528). No significant associations were found with molar relation neither at ANB (p = 0.2075) nor at the WITS (p = 0.4794) appraisal. Significant positive correlations between ANB and WITS appraisal were found at the three incisal classification classes (class I, r = 0.73; class II, r = 0.64; class III, r = 0.75) and no significant correlation was observed in all classes with the Angle's (molar) classification.

Conclusions

The incisal classification had a significant association with WITS appraisal, whereas with ANB the association was marginally significant. No correlation was found between Angle's (molar) classification and ANB or WITS appraisal.

Clinical significance

The incisal relation could be considered as a good indicator of the skeletal malocclusion in the sagittal plane in the orthodontic practice.

How to cite this article

Al-Hamlan N, Al-Eissa B, Al-Hiyasat AS, Albalawi FS, Ahmed AE. Correlation of Dental and Skeletal Malocclusions in Sagittal Plane among Saudi Orthodontic Patients. J Contemp Dent Pract 2015;16(5):353-359.
Employment of Reservoirs in At-Home Whitening Trays: Efficacy and Efficiency in Tooth Whitening
Authors: Qian Fang , Geisinger Serena , Kwon So Ran
Published: June 2015

Aim

This study aimed to determine the efficacy of trays made with and without reservoirs, in conjunction with time and cost evaluations, by measuring color change with home whitening procedures.

Materials and methods

Extracted human maxillary teeth (central incisors n = 20; canines n = 20; molars n = 20) and 60 artificial teeth (lateral n = 20; premolar n = 40) were mounted into ten typodonts. Tray fabrication was completed such that a blockout resin reservoir was placed on half of the buccal surface of the tray, while the other half remained without a reservoir. Whitening with custom fabricated trays was performed based on two different whitening regimens, where each regimen was assigned to five typodonts: Night-time: Opalescence PF 10% carbamide peroxide for 8 hours daily and Day-time: Philips DayWhite 9.5% hydrogen peroxide for 30 minutes, twice daily. Both systems were applied for 1 week. To evaluate tooth shade, the VITA Easyshade® Advance 4.0 spectrophotometer was used. Color measurements were obtained at baseline (T1), 1-day post-whitening (T2), and 1 month post-whitening (T3). One-way ANOVA, followed by post-hoc Tukey's HSD test, was used to detect significant difference in the overall color change (ΔE*) among the four groups at T2 and T3. Additionally, paired-sample t-test was used to assess difference in ΔE* between T2 and T3 treatment within each of four techniques of tray fabrication.

Results

No significant difference in ΔE* was found among the four groups at T2 and T3 (p > 0.05 in each instance). There were significant differences in mean ΔE* between T2 and T3 treatment for the day white treatment groups without reservoir (6.96 vs 10.19 respectively; p = 0.0026) and with reservoirs (6.23 vs 9.79 respectively; p = 0.0031).

Conclusion

The use of reservoirs does not have a significant effect on whitening efficacy, regardless of type of whitening material and regimen.

Clinical significance

The use of custom fabricated trays with or without reservoirs were equally effective in whitening teeth.

How to cite this article

Geisinger S, Kwon SR, Qian F. Employment of Reservoirs in At-Home Whitening Trays: Efficacy and Efficiency in Tooth Whitening. J Contemp Dent Pract 2015;16(5):383-388.
Management of Impacted Maxillary Central Incisor: Modified Nance Arch Application
Authors: Mannathoko-Molefhe Bonolo , Rongdang Hu
Published: June 2015

This is a case report of a patient who presented to Wenzhou Medical University—Orthodontic Department at 8 years of age with missing right maxillary central incisor. A detailed clinical and radiographic examination was carried out and treatment plan formulated to surgically expose the impacted incisor and use the modified nance arch (MNA) appliance for orthodontic traction of the tooth in line of arch as phase one treatment followed by phase two treatment with fixed appliances.

How to cite this article

Mannathoko-Molefhe B, Hu R. Management of Impacted Maxillary Central Incisor: Modified Nance Arch Application. J Contemp Dent Pract 2015;16(5): 415-421.
Interdental Implant Papillae Grow up with Temporary Abutment displaced at Monthly Intervals
Authors: AL-Jubooria Mohammed Jasim
Published: June 2015

Interdental papillae regeneration remains a challenge in implant dentistry in cases in which papillae are lost following tooth extraction. This report presents an implant case with missing 1st and 2nd premolars and total papillary loss. We performed immediate provisionalization to the first premolar implant with a temporary abutment and crown, whereas the second premolar was submerged. Crown contouring and modifications to the shape and size were performed once every month (the temporary abutment and crown disconnected three times during the 3-month healing period). At the end of the 3-month healing period, papillae regeneration was observed between the implant and the adjacent tooth and between the adjacent implants. Papillae regeneration is possible with temporary abutment and a composite material crown that is properly contoured and polished, even with several abutment removals during the healing period.

How to cite this article

AL-Juboori MJ. Interdental Implant Papillae Grow up with Temporary Abutment displaced at Monthly Intervals. J Contemp Dent Pract 2015;16(5):422-426.
Local health department workers, public policy, and willingness to respond during emergencies
Authors: Rutkow, JD, PhD, MPH Lainie , Vernick, JD, MPH Jon S. , Thompson, MS, MBA Carol B. , Hudson, MSN Robert , Barnett, MD, MPH Daniel J.
Published: June 2015

Objectives: To determine whether an association exists between a state's authority to declare a public health emergency and local public health workers’ response willingness.Design: The 2009-2010 Johns Hopkins~Public Health Infrastructure Response Survey Tool included questions about demographics and attitudes/beliefs regarding local public health workers’ response willingness during public health emergencies. Survey data were merged with data about presence/absence of a law granting states the authority to declare a public health emergency. Logistic regression analyses were performed with the presence/absence of the law and were adjusted for individuals’ demographic and locale characteristics.Setting: Data were collected from eight clusters of local health department workers in nine states.Participants: Two thousand nine hundred ninety-three local health department workers.Main outcome measure: Willingness to respond to four different public health emergency scenarios.Results: For naturally occurring and human-caused disasters, in unadjusted analyses, there was no statistically significant difference in willingness to respond between individuals living in states with a law that allowed for a governmental declaration of public health emergency and those living in states without such a law. Adjusted analyses yielded similar results.Conclusions: While laws giving the state the authority to declare a public health emergency are not associated with response willingness, findings may reflect the fact that states rarely declare public health emergencies, giving local public health workers few opportunities to become familiar with the implementation of these laws. In light of this, local health departments should consider altering their own internal policies to promote response willingness among their employees.
Development of a disaster preparedness curriculum for medical students: A pilot study of incorporating local events into training opportunities
Authors: Pollard, BA Katherine A. , Bachmann, MD Daniel J. , Greer, MD, MPH Marek , Way, MEd David P. , Kman, MD Nicholas E.
Published: June 2015

Objective: Contemporary disasters, like the outbreak of Ebola in West Africa, have piqued the interest of medical students in disaster preparedness. The topic is also a requirement of undergraduate medical education.1 Yet current literature suggests that disaster preparedness education is lacking. Our objective was to pilot a curriculum to augment medical students’ disaster preparedness education by marshalling local resources to provide practical hands-on experiences.Design: This pilot curriculum consisted of lectures; simulations; asynchronous learning materials; a large-scale, regional disaster exercise; and preparation for and participation in a real-time mass gathering. Outcomes were measured by student performance on written tests and evaluations of each activity. Setting: Academic Health Center with associated medical school.Participants: Fifty-two medical students participated in at least one of the six activities during this voluntary pilot program. Premedical students and residents (n = 57) participated in some activities.Results: Forty-one medical students took either the pretest or the post-test over the curriculum. Only eight students took both. A paired t test comparing pretest to post-test scores using imputed missing data (t = −11.72, df = 40, p ≤ 0.001) was consistent with an analysis using only complete data (t = −2.35, df = 7, p = 0.05), implying that student scores improved significantly over time. Evaluations indicated a student preference for hands-on over didactic or independent learning activities.Conclusions: This pilot curriculum was designed to capitalize on practical hands-on training opportunities for our medical students, including participation in a disaster exercise and a mass-gathering event. These opportunities provided effective and engaging disaster preparedness education.
Using urine drug testing to support healthy boundaries in clinical care
Authors: Heit, MD, FACP, FASAM Howard A. , Gourlay, MD, MSc, FRCPC, FASAM Douglas L.
Published: June 2015

Risk management is first and foremost about protecting patients. This article will examine risk management in general, and urine drug testing (UDT) in particular, as core constituents in an effective, comprehensive risk management strategy. The article will explore UDT as a tool to help practitioners and patients make better choices in the clinical management of chronic pain. How one makes these difficult clinical decisions based on UDT results as well common barriers encountered in conducting patient-centered UDT will also be examined.
Treatment changes following aberrant urine drug test results for patients prescribed chronic opioid therapy
Authors: Morasco, PhD Benjamin J. , Krebs, MD, MPH Erin E. , Cavanagh, MS Renee , Hyde, MA Stephanie , Crain, MSW Aysha , Dobscha, MD Steven K.
Published: June 2015

Background/objective: Urine drug testing (UDT) may be used to help screen for prescription opioid misuse. There are little data available describing usual pain care practices for patients who have aberrant UDT results. The goal of this research was to evaluate the clinical care for patients prescribed chronic opioid therapy (COT) and have an aberrant UDT.Design: Retrospective cohort study.Setting: VA Medical Center in the Pacific Northwest.Participants: Patients with chronic pain who were prescribed COT and had a UDT result that was positive for an illicit or nonprescribed substance.Main outcome measures: This was an exploratory study designed to document usual care practices.Results: Participants' (n = 83) mean age was 49.5 (SD = 9.6) and 81.5 percent were male. The most common substances detected on UDT were marijuana (69 percent) or a nonprescribed opioid (25 percent); 18 percent had a UDT positive for two or more substances. Plans to modify treatment were documented in 69 percent of cases. The most common treatment change after aberrant UDT results was instituting more frequent UDTs, which occurred in 43 percent of cases. Clinicians documented plans to alter their opioid prescribing (eg, terminating opioids, requiring more frequent fills, changing opioid dose, or transitioning to another opioid) in 52 percent of cases, but implemented these changes in only 24 percent.Discussion: Current methods for optimizing treatment after obtaining aberrant UDT results should be enhanced. To improve the utility of UDT to reduce prescription opioid misuse, additional interventions and support for clinicians need to be developed and tested.
Specimen validity testing in urine drug monitoring of medications and illicit drugs: Clinical implications
Authors: Kirsh, PhD Kenneth L. , Christo, MD, MBA Paul J. , Heit, MD Howard , Steffel, PharmD Katherine , Passik, PhD Steven D.
Published: June 2015

Objective: To discuss the importance of specimen validity testing (SVT) in urine drug testing (UDT) and the clinical role it plays in identifying efforts to subvert the UDT process.Methods: A discussion of the clinical impact of SVT is presented.Results: A discussion of pH, specific gravity, creatinine, and oxidation for monitoring the adulteration of UDT samples is presented along with the clinical significance of such tests.Significance: SVT has a significant place in healthcare efforts to measure patient adherence, behavior, and honesty in communication with clinicians. SVT is typically ordered by treating clinicians who use the results to make therapeutic decisions regarding specific medical problems of their patient, including those related to medication and illicit drug use. In the absence of SVT, a healthcare provider may fail to identify a patient's adulteration of their urine sample in an attempt at deceiving the provider. Moreover, the presence of some underlying medical conditions may obfuscate the UDT results.
Medication monitoring and drug testing ethics project
Authors: Payne, MD Richard , Moe, PhD Jeffrey L. , Sevier, DrPH Catherine Harvey , Sevier, MS David , Waitzkin, JD, LLM Michael
Published: June 2015

In 2012, Duke University initiated a research project, funded by an unrestricted research grant from Millennium Laboratories, a drug testing company. The project focused on assessing the frequency and nature of questionable, unethical, and illegal business practices in the clinical drug testing industry and assessing the potential for establishing a business code of ethics. Laboratory leaders, clinicians, industry attorneys, ethicists, and consultants participated in the survey, were interviewed, and attended two face-to-face meetings to discuss a way forward.The study demonstrated broad acknowledgment of variations in the legal and regulatory environment, resulting in inconsistent enforcement of industry practices. Study participants expressed agreement that overtly illegal practices sometimes exist, particularly when laboratory representatives and clinicians discuss reimbursement, extent of testing, and potential business incentives with medical practitioners. Most respondents reported directly observing probable violations involving marketing materials, contracts, or, in the case of some individuals, directly soliciting people with offers of clinical supplies and other “freebies.”While many study respondents were skeptical that voluntary standards alone would eliminate questionable business practices, most viewed ethics codes and credentialing as an important first step that could potentially mitigate uneven enforcement, while improving quality of care and facilitating preferred payment options for credentialed parties. Many were willing to participate in future discussions and industry-wide initiatives to improve the environment.
Root cause analysis of prescription opioid overdoses
Authors: Wawrzyniak, PsyD Kelly M. , Sabo, MD Alex , McDonald, RN, MN Ann , Trudeau, PhD Jeremiah J. , Poulose, MD Mon , Brown, PhD Mary , Katz, MD, MS Nathaniel P.
Published: June 2015

Overdoses (ODs) of prescription opioids (RxOs) have become a major public health issue in the United States.Objective: To determine the root causes of accidental prescription opioid overdoses (RxO-OD).Design/setting/participants/intervention: The authors conducted a root cause analysis using the Antecedent Target-Measurement method, interviewing three types of key informants: survivors of RxO-ODs, family members, and clinical experts.Results: Ten survivors, five family members, and three experts were interviewed. Proximal causes of RxO-ODs described by survivors and family members were recent RxO dose escalation (n = 9), polysubstance use (n = 5), and polypharmacy use (n = 3). Proximal causes were elicited by the following six antecedent causes: wanting to feel good/high (n = 9), perceived tolerance to RxO (n = 6), didn't know/believe it was dangerous (n = 5), wanting to reduce psychosocial pain (n = 5), wanting to reduce physical pain (n = 4), and wanting to avoid discomfort due to withdrawal symptoms (n = 4). RxOs involved in the OD were either prescribed by a doctor (n = 7), purchased from a dealer (n = 6), given/purchased from family/friends (n = 3), or stolen from family (n = 1). Psychosocial stressors (n = 9), chronic recurrent depression (n = 3), and chronic substance abuse/addiction (n = 4) were also distal and proximal causes of OD. Experts cited similar causes but added prescriberrelated causes (eg, inadequate training) and healthcare system and culture.Conclusions: Patients at risk for OD can be identified and ODs potentially prevented. Opportunities for intervention include routine screening of patients using RxOs for psychosocial distress and coping, flagging of high-risk patients, care pathways for high-risk patients, clinician and patient training on OD prevention, and developing abuse-deterrent formulations of RxOs.
Randomized double-blind placebo trial of duloxetine in perioperative spine patients
Authors: Hyer, PhD, ABPP Lee , Scott, MS, NCC Ciera , Mullen, MA Christine M. , McKenzie, BA Laura C. , Robinson Jr, MD Joe Sam
Published: June 2015

Objective: This study describes a single-site investigation on the effects of a randomized double-blind placebo trial targeting duloxetine added to opioid use (duloxetine + opioid) against a comparator (placebo + opioid) in spine surgery patients, independent of major depression.Design: The double-blind comparator study assessed two groups on opioids: one using duloxetine and the other a placebo. Subjects were administered the respective medication 2 weeks prior to surgery and continued on this for more than 3 months. Subjects were assessed at three times: prior to surgery, 4 weeks postsurgery, and 12 weeks postsurgery. They completed a battery of tests assessing for pain, adjustment, and psychiatric problems.Setting: Neurosurgical outpatient and inpatient setting.Patients: Sixty-eight patients completed the study. They received one of three types of elective spine surgery.Interventions: Subjects were given duloxetine or placebo 2 weeks prior to surgery and continued with the regimen for more than 3 months.Outcomes: The primary focus was pain and second on adjustment factors and psychiatric symptoms: depression and anxiety. The amount of opioid use presurgery and postsurgery was also evaluated.Results: There were differences among the groups on Brief Pain Inventory (BPI)-Average, the core pain marker, and BPI-Sleep. Within-subject analyses showed that duloxetine subjects improved significantly from baseline. For function, post-CIBIC and post-Functional Adjustment Questionnaire were significant, favoring duloxetine. Reduction of opioid use was not a factor; both groups' utilization declined. For affect, both groups were significantly improved over time.Conclusions: Duloxetine seems to improve pain, assist with maintaining function, and reduce intensity of affect.
Intractable pruritus during outpatient epidural hydromorphone infusion: A case report and a focused review of the literature
Authors: Ruan, MD Xiulu , Ma, MD, PhD Li , Couch, MD J. Patrick , Chen, MD, PhD Tao , Bumgarner, PhD Gary W.
Published: June 2015

Background: Intraspinal drug delivery therapy has been increasingly used in patients with intractable, nonmalignant pain who have failed to respond to conventional treatment or cannot tolerate systemic opioid(s) due to adverse events. By infusing a small dose of an opioid analgesic directly into the cerebrospinal fluid, near opioid receptors, profound spinal analgesia can be obtained. Before the implantation of permanent intraspinal pump, a neuraxial opioid infusion trial is usually conducted to demonstrate the effectiveness of neuraxial opioid for analgesia. Patient-controlled epidural opioid infusion trial, performed in an outpatient setting, is one of the approaches used to conduct such a trial.Objective: To report a case of severe pruritus observed during the continuous epidural hydromorphone infusion trial and to conduct a focused review of the literature.Case report: An otherwise healthy 56-year-old lady, with a 4-year history of severe low back pain and bilateral leg pain due to failed back surgery syndrome, was referred to our clinic for intraspinal drug delivery therapy. Following a preimplantation psychological evaluation confirming her candidacy, she consented to an outpatient patient-controlled continuous epidural hydromorphone trial. A tunneled lumbar epidural catheter was placed at L3-L4 with catheter tip advanced to L2 under fluoroscopic guidance. Satisfactory catheter placement was confirmed by epidurogram. The catheter was then tunneled subcutaneously and connected to a Microject™ patient-controlled epidural analgesia (PCEA) pump (Codman, Raynham, MA). The pump was programmed to deliver hydromorphone 0.3 mL/h (0.06 mg, concentration 0.2 mg/mL) at basal rate of 0.3 mL/h, with bolus dose set at 0.2 mL (0.04 mg) and 30-minute lockout interval. The patient was instructed how to operate the infusion pump prior to discharging home. During the infusion trial, she reported satisfactory analgesia (>90 percent pain reduction) and was able to reduce her oral opioid dose by more than 80 percent. However, she developed severe, persistent itching, unresponsive to meticulous epidural infusion titration or various antipruritic treatments. Her pruritus remained severe and unabated until a few hours after the termination of the epidural hydromorphone infusion.Conclusion: Pruritus may occur and persist during epidural hydromorphone infusion. This report describes severe pruritus in a patient on epidural hydromorphone administration, in the setting of an outpatient infusion trial.