The importance of intensive follow-up and achieving optimal chronic antithrombotic treatment in hospitalized medical patients with anemia: A prospective cohort study.

BACKGROUND: Anemia is a global health concern, particularly among the elderly on chronic antithrombotic treatment. Close monitoring of hemoglobin (Hb) levels and achievement of an optimized treatment significantly enhance patients' quality of life. This study aimed to examine the impact of antithrombotic treatment on Hb levels and readmissions in hospitalized patients with anemia. METHODS: This is a prospective cohort study of patients admitted to the Department of Internal Medicine of the University Hospital of Heraklion, Greece, from November 2021 to October 2022 with the diagnosis of anemia while receiving antithrombotic treatment. Data regarding demographics, past medical history, and laboratory and endoscopy findings were recorded. For those receiving inappropriate therapy according to international guidelines, antithrombotic treatment was optimized. Subsequent follow-ups occurred at one and six months post-discharge. Six- and twelve-month anemia-caused readmissions, as well as annual mortality, were evaluated. RESULTS: In total, 104 patients were assessed. Among them, 34.6% were on antiplatelets, 56.7% were on anticoagulants, and 8.7% were on combination treatment. The mean age was 80 ± 8.2 years, and 54.8% were males. On admission, mean Hb levels were 6.86 ± 1.23 g/dL, while 56 (53.8%) patients had severe anemia. Gastroscopy and colonoscopy were performed in 75.0% and 41.4% of patients, respectively, confirming gastrointestinal bleeding in most of the cases. Treatment optimization was carried out for 56 patients. Follow-up revealed elevated Hb levels after one and six months post-discharge, while anemia-related readmissions stayed below 10%. CONCLUSIONS: Most hospitalized anemic patients on antithrombotic treatment had endoscopic findings favoring gastrointestinal bleeding. Half received inappropriate antithrombotic therapy. Treatment optimization and regular follow-up improved Hb levels and reduced readmissions.

Tooth Extraction in Antiquity.

Tooth extraction was probably the first dental treatment in human history, therefore a tooth forceps usually stood out as its symbol. The procedure in these early years was not easy and it posed many risks. Those extracting the teeth prepared several medicaments in order to remove them without pain or to minimize effort. In the ancient medical literature, there are a plethora of references to medicaments that were used for extracting the teeth, and although it seemed like an appealing idea, it did not offer much in painless practice. Only in cases where the pain was unbearable and any effort to relief the process with drugs failed, only then was the tooth forceps used. Just a few forceps have survived in Europe, due to the deterioration of their material used for their construction. The study of instruments that were unearthed came to the conclusion that these surgical instruments which were used not only for tooth extraction but also, for the extraction of arrows and bone fragments. However, those instruments were not anatomically designed to adapt to the cervix of the tooth. At the same time, the steps of the extraction procedure resembled those used today. At first a sharp surgical instrument was used to separate the tooth from the soft gum tissue. Then, the tooth was grabbed with the forceps and were used in rocking movements. When the tooth was loose enough, they pulled it out using their fingers. In case that this was not possible, the final step for the extraction was done with forceps. Only doctors, usually surgeons, used the forceps. There are also references for root forceps. In Greece, three forceps have been excavated until now. The oldest is dated to the 5th century B.C.

Differential pharmacology and clinical utility of dapagliflozin in type 2 diabetes.

Dapagliflozin belongs in the family of sodium-glucose cotransporter 2 (SGLT2) inhibitors and acts by reducing glucose reabsorption in the proximal tubule. The aim of this review is to present the differential pharmacology and clinical utility of dapagliflozin. Dapagliflozin is orally administered, has a long half-life of 12.9 hours and (similar to empagliflozin) is a much weaker SGLT1 inhibitor compared with canagliflozin. Dapagliflozin significantly decreases glycated hemoglobin and fasting glucose levels in patients with type 2 diabetes mellitus (T2DM). The drug improves body weight, blood pressure, uric acid, triglycerides and high-density lipoprotein cholesterol. In the DECLARE-TIMI 58 trial, a large trial of 17,160 T2DM patients with established cardiovascular disease (CVD) or without established CVD but with multiple risk factors, dapagliflozin compared with placebo resulted in a significantly lower rate of the composite outcome of CVD death or hospitalization for heart failure (HHF); this effect was mainly due to a lower rate of HHF in the dapagliflozin group (HR: 0.73; 95%CI: 0.61-0.88), whereas no difference was observed in the rate of CVD death (HR: 0.98; 95%CI: 0.82-1.17). Moreover, dapagliflozin was noninferior to placebo with respect to major adverse CVD events. Dapagliflozin exerts beneficial effects on albuminuria. Additionally, in the DECLARE-TIMI 58 trial it significantly reduced the composite renal endpoint (40% decrease in glomerular filtration rate, end stage renal disease, or renal death) in both patients with established CVD and patients with multiple risk factors (overall HR: 0.53; 95%CI: 0.43-0.66). However dapagliflozin, like the other SGLT2 inhibitors, is associated with an increased risk of genital and urinary tract infections (usually mild mycotic infections) and acute kidney injury in cases of reduced extracellular volume. Dapagliflozin is a useful antidiabetic treatment which also exerts beneficial effects in the management of heart failure and diabetic kidney disease.

Evaluation of a new fluorescence-based device in the detection of incipient occlusal caries lesions.

The aim of this in vitro study was to evaluate the performance of various contemporary detection tools at incipient occlusal caries. Thirty eight freshly extracted posterior teeth with non-cavitated occlusal caries were subjected to clinical examination and coding according to ICDAS criteria (n = 38). Standardized fluorescence images were taken with VistaProof (Dürr Dental, Bietigheim-Bissingen, Germany). Furthermore, the teeth were calculated with a laser fluorescence pen device (DIAGNOdent pen, Kavo, Biberach, Germany). In all detection methods, assessment of caries was performed twice (with 1-week interval) by two calibrated examiners. Finally, the caries lesions were validated in tooth sections by histological examination. The intra-examiner and inter-examiner kappa coefficient, sensitivity, and specificity were determined for all detection methods at enamel lesions (D1 threshold). Degrees of agreement of each method with the histological status were calculated using receiver operating characteristic statistics and the area under curve (Az values). The kappa intra-examiner/inter-examiner coefficient values (mean ± SD) were 0.74 ± 0.04/0.73 ± 0.07, 0.87 ± 0.04/0.82 ± 0.07, and 0.91 ± 0.06/0.83 ± 0.08 for clinical examination, DIAGNOdent pen, and VistaProof, respectively. The sensitivity for ICDAS was 0.80-0.86, for DIAGNOdent pen was 0.66-0.75, and for the VistaProof device was 0.97. The specificity for all the detection methods were 0.5 (0.02-0.99). The accuracy value for ICDAS was 0.76-0.81, for DIAGNOdent pen 0.66-0.71, and for the VistaProof device 0.92-0.95. The Az values (mean ± SD) were 0.431 ± 0.187, 0.583 ± 0.215, and 0.486 ± 0.207 for ICDAS, DIAGNOdent pen, and VistaProof examination, respectively. No significant differences in Az values were noted among the methods. All detection methods were presented with high inter-examiner and intra-examiner agreement. The new VistaProof device showed the best sensitivity, while DIAGNOdent pen demonstrated the worst one. Specificities were the same for all detection methods. Moreover, they presented the same performance in detection of incipient occlusal caries.

Unusual death due to a bleeding from a varicose vein: a case report.

BACKGROUND: Varicose veins are a common entity presenting a worldwide distribution. Although they are usually benign, sometimes are proved to be a threatening condition. Massive hemorrhage is an unusual complication of this common venous pathology that demands immediate medical intervention. CASE PRESENTATION: We present a case of a 66-year-old woman found dead in her house surrounded by a large quantity of blood. Autopsy revealed a 7 mm ulcer on the internal surface of the left lower leg communicating with a varicose vein, signs of exsanguinations and liver cirrhosis. Toxicological analysis was negative. CONCLUSION: Massive hemorrhage from a ruptured varicosity is a severe medical emergency. Awareness of the risk of massive hemorrhage may provoke preventive treatment to be undertaken so as terminal loss of consciousness and a subsequent unattended death to be averted.

In vitro evaluation of fluoride and calcium sodium phosphosilicate toothpastes, on root dentine caries lesions.

OBJECTIVES: The aim of this in vitro study was to assess the effect of toothpastes containing three different sodium fluoride concentrations and a calcium sodium phosphosilicate system, on root dentine demineralization and remineralization. METHODS: During a fourteen-day pH-cycling protocol, pre-softened bovine root dentine specimens were immersed twice daily, before and after the demineralization periods, for 2 min, in the following toothpaste slurries: (a) non-fluoridated (control), (b) 7.5% calcium sodium phosphosilicate, (c) 1450 ppm F, (d) 2800 ppm F, and (e) 5000 ppm F. Subsequently, the slabs were subjected to a fifty-hour acid resistance test. Knoop microhardness at different lesion depths was assessed in specimen cross-sections and KHN values were converted to vol.% mineral. Comparisons between the groups were performed at each lesion depth through ANOVA-based tests and furthermore, regression analysis of the derived statistic of "integrated vol.% mineral loss" was carried out. Also, lesions were evaluated qualitatively using transmission and polarized light microscopy. RESULTS: The 5000 ppm F toothpaste group, during pH-cycling, presented significantly less total vol.% mineral loss and subsequently exhibited considerably increased surface acid resistance, compared to all the other tested groups. The calcium sodium phosphosilicate toothpaste, during pH-cycling, inhibited demineralization and/or promoted remineralization of the surface layers significantly more effectively than the control group nevertheless, subsequently, the acid resistance of the calcium sodium phosphosilicate dentifrice group was similar to that of the control group. These observations were confirmed by microscopic examination of the lesions. CONCLUSIONS: Under the present experimental conditions, the 5000ppm F toothpaste, promoted remineralization and inhibited demineralization more effectively, than the other tested toothpastes.

A study on colour stability of self-etching and etch-and-rinse adhesives.

OBJECTIVES: The purpose of this study was to investigate the color change in two "self-etch" and one "etch and rinse" adhesive under dark/water and photoaging conditions and to evaluate the influence of these changes on the color stability of resin composite restorative systems. METHODS: The adhesives were: One-Up Bond F (OB/Tokuyama), Adper Prompt L-Pop (PL/3M Espe) and Optibond Solo Plus (OS/Kerr). 10 sample disks of each material were prepared (OB(1), LP(1), OS(1)). Additionally, 30 sample discs of TPH Spectrum (Caulk/Dentsply) resin composite were prepared and bonded with the three adhesives tested (OB(2), LP(2), OS(2) groups) to freshly cut dentin discs. 30 days of storage in deionised water (37+/-1 degrees C) in dark conditions was followed by exposure of all samples to UV light photoaging. A colorimetric evaluation (CIEL*a*b* system) was performed immediate after sample photopolymization (baseline), at 7 and 30 days of dark/water storage and after the 360h of UV aging. Color changes (DeltaE*) were calculated between baseline and subsequent measurements. The results were analyzed by independent two-way Anova and Sheffe's statistical tests (a=0.05). RESULTS: All the adhesives evaluated exhibited significant color changes even after early aging time into water. One-Up Bond F presented the highest color alterations under both experimental conditions and Optibond Solo Plus the lowest. The adhesives were proved able to influence the color stability of a resin composite, which is bonded to a dentin substrate. One-Up Bond F induced the strongest effect on color change of the resin composite while no differences were clarified between Adper Prompt L-Pop and Optibond Solo Plus. CONCLUSION: Significant color changes were determined under water and photoaging conditions for the "self-etch" and "etch and rinse" adhesives evaluated and the resin composite combined with these agents.

Characterization of oral films formed in the presence of a CPP-ACP agent: an in situ study.

OBJECTIVES: The aim of this study was to compare the morphological appearance and the molecular composition of intraoral integuments formed in situ on germanium (Ge) crystals in the presence or absence of the commercially available casein-phosphopeptide-amorphous calcium phosphate (CPP-ACP) cream agent. METHODS: Six volunteers participated in the study. Impression of maxillary arch was taken for each patient, and a removable orthodontic appliance with a custom-made retainer was fabricated. Clean Ge crystals mounted in the retainers were placed intraorally for 30 min, 8, 24 h and 1-week period. The free sampling surface of another series of Ge crystals was treated with the commercial CPP-ACP agent (Tooth Mousse), mounted in the retainers and placed intraorally for the same period as above. The free exposed surfaces in oral cavity of the specimens in all subjects were examined as follows: (a) reflected light microscopy, (b) micro-MIR-FTIR spectroscopy and (c) scanning electron microscopy (SEM) plus energy-dispersive X-ray microanalysis analysis (XEDS). RESULTS: The light microscopic observations revealed that there was a delay in biofilm formation on Ge surfaces treated with agent in comparison to those ones without treatment. The micro-MIR-FTIR spectra from the surfaces with Tooth Mousse showed an increase in intensity and a left shift of PO(4)(3-) peak (1064 cm(-1)). Finally, the PO(4)(3-) peak at lower bands (564 cm(-1)) and the low-wave bands at 525-530 cm(-1) increased at 1-week interval. The SEM revealed the dendritic development of microbes. The XEDS analysis showed a significant increase in Cl/O, K/O, K/Cl and a decrease in Ca/O and P/O ratios on the crystal Ge without surface treatment. On contrary, on the crystal Ge with surface treatment an increase in Ca/O, Ca/P and a decrease in K/Cl ratios were found. CONCLUSION: The results show that the presence of CPP-ACP agent delays the biofilm formation and favored the nucleation and crystallization of calcium phosphates, possibly in apatitic form, in matured biofilms.

Effect of a CPP-ACP agent on the demineralization and remineralization of dentine in vitro.

OBJECTIVES: The aim of this study was to determine in vitro the effect of a commercial paste based on CPP-ACP complex on the demineralization of sound human dentine and on remineralization potential of artificial caries-like lesions formed on dentine surfaces. METHODS: Forty dentine specimens were prepared with hard tissue microtome. The specimens were divided in four groups the A, B, C and D (n=10). The specimen surfaces were subjected to surface analysis by Fourier transformance micro multiple internal reflectance infrared spectroscopy (micro MIR-FTIR). Tooth mousse was applied on surface specimens of A group, while no agent were applied on the specimens of B group. Afterwards, groups A, B, C and D were immersed in demineralization solution for 7 days. Afterwards, the surfaces were subjected to micro MIR-FTIR analysis and the mineral to matrix ratio was used to assess the extent of dentin demineralization (DM). Tooth mousse was applied on specimens of group C, while no agent was applied on specimens of group D. The groups C and D immersed in artificial saliva for 7 days and were subjected to analysis by micro MIR-FTIR and the mineral to matrix ratio was used to assess the extent of dentin remineralization (RM). RESULTS: Group A showed significant lower %DM in comparison to group B. Group C resulted in a significant higher %RM compared to group D. CONCLUSIONS: The presence of agent CPP-ACP on dentine surfaces provoked lower demineralization and higher remineralization in comparison with the dentine surfaces without agent.

Curing efficiency of various types of light-curing units.

This study compared monomer conversion (DC), the per cent linear polymerization shrinkage (%LS), the wall-to-wall contraction pattern (per cent of peripheral opening, %DM, and maximal marginal gap, MG) and depth of cure (DOC), of a hybrid resin composite (Spectrum TPH) exposed to different types of light-curing units and exposure modes (Virtuoso-PAC, Elipar TriLight-QTH, and FreeLight-LED). The QTH and LED units were used in two curing modes: the exponential ramp and the continuous output modes. Monomer conversion was investigated by micro Multiple Internal Reflection (MIR)-Fourier-transform infrared (FTIR) spectroscopy and %LS was measured by the deflective disc method. The wall-to-wall contraction method used a cylindrical cavity model in extracted human teeth. The per cent debonded margins relative to the cavity periphery (%DM) and the width of maximum gap (MG) was evaluated. The DOC was determined using Vickers microhardness measurements (200 g load, 20 s) at the top surface (H0), at 2 mm (H2) and at 4 mm (H4) depths, and the results expressed as H2/H0 and H4/H0 ratios. Significantly lower %DC and %LS values were provided by PAC and LED units. No differences were found in %DM among the curing units and PAC exhibited the highest MG. No significant differences were noted among light-curing groups in terms of H2/H0 microhardness values. The QTH, operated in exponential mode, resulted in the highest H4/H0 value. The exponential mode of the QTH demonstrated superior performance for the total of the characteristics evaluated.

A comparative clinical study on the Carisolv caries removal method.

OBJECTIVE: Carisolv is a relatively new chemomechanical method for caries removal. The aim of this clinical study was to compare Carisolv with the conventional drilling technique. METHOD AND MATERIALS: Forty-five volunteers, ages 18 to 55 years, each with two contralateral primary coronal mesio-occlusal or disto-occlusal carious lesions, similar in extent, participated in the study. Two calibrated operators treated all lesions. One operator treated both lesions in one visit (one lesion with Carisolv and the other with conventional drilling). Following the filling procedure, the opinion of each patient regarding each caries removal method was recorded. The need for drilling in addition to the Carisolv application, the time required for caries removal, the need for anesthesia, and the gingival reaction to the Carisolv gel were recorded by each operator for each case. RESULTS: The patients found Carisolv treatment more pleasant (82%) and preferable (88%) to drilling. Of the patients treated with drilling, 40% required anesthesia compared to the 8% treated with Carisolv. Additional drilling for complete caries removal was needed in 10% of Carisolv-treated lesions. Carisolv induced no gingival reaction. Significantly longer times were required for caries removal with Carisolv (12.2 +/- 4.1 minutes) compared to drilling (6.8 +/- 2.8 minutes). CONCLUSIONS: The Carisolv technique was: (a) accepted by the majority of patients, (b) efficient for caries removal, (c) considered a time-consuming technique for the dentists, and (d) considered less dependent on local anesthesia.