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1.
J Indian Prosthodont Soc ; 20(1): 3-10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32089593

RESUMO

In the era of evidence based dentistry, a well-documented consolidated data about improvements in dentistry is a necessity. Concentrated growth factor (CGF) is an emerging trend in periodontology and now in implant dentistry. Various studies have been published in the literature evaluating the effect of CGF on implant osseointegration, implant stability, survival rate, sinus augmentation, and peri-implant defects. However, no systematic review has yet been documented. The present systematic review, being first of its kind, aimed to evaluate the potential outcomes of employing CGF in implant treatment. A literature search was carried out in PubMed and Google scholar for articles published between 2001 and 2019, with various keywords such as "CGF," "dental implant," "bone regeneration," "CGF," and "osseointegration." The screening of studies was done according to PRISMA guidelines. A total of eleven studies were included in this review. Majority of the included studies pointed toward the beneficial effects of CGF in implant treatment. CGF was seen to promote osseointegration and enhance bone regeneration. Although more clinical studies are required to validate the potential merits of CGF in the long run, the preliminary results seem promising.

2.
J Indian Prosthodont Soc ; 16(1): 70-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27134431

RESUMO

INTRODUCTION: From the point of dental practice, the restoration of endodontically treated teeth has become an important aspect as it involves a range of treatment options of variable complexity. Restoring teeth with insufficient coronal tooth structure, it is always indicated to use the post to retain a core for definitive restoration. Fiber post has a modulus of elasticity in analogs to dentin structure, thus reducing the stress areas at the dowel dentin interface. However, the only material that can substantiate all these properties can be none other than dentin itself. MATERIALS AND METHODOLOGY: Three-dimensional (3D) models of the maxillary central incisor were developed incorporating all the nonlinearities. Continuum 3D elements were used in three dimensions. Maxillary central incisor was laser scanned, duplicated with the help of reverse engineering into STL format, and it was converted into 3D model for finite element analysis (FEA). For the model, fixed boundary conditions were applied at the outer bone, while 100 N static vertical occlusal loads were prescribed at 135° on the loading component of the simulated tooth. The stress distribution was evaluated using dentin and fiber post with prescribed materials, loading and boundary conditions in endontically treated teeth by 3D FEA. RESULTS: The analysis for von Misses stress for dentin post showed that the stress in the dentin post at the cervical area was 127 MPa. The displacement in the dentin post was <0.025 mm. Von Misses stress for the fiber post at the cervical area was approximately 182 MPa and the displacement was <0.035 mm. CONCLUSION: The FEA results showed that the stress in the cervical area of the dentin was more for fiber post when compared to dentin post, and maximum displacement values were less for dentin post in comparison to fiber post.

3.
J Stroke Cerebrovasc Dis ; 23(5): 844-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-23954600

RESUMO

BACKGROUND: Recent reports suggested better outcomes associated with the drip-and-ship paradigm for acute ischemic stroke (AIS) treated with thrombolysis. We hypothesized that a higher rate of stroke mimics (SM) among AIS treated in nonspecialized stroke centers that are transferred to comprehensive centers is responsible for such outcomes. METHODS: Consecutive patients treated with thrombolysis according to the admission criteria were reviewed in a single comprehensive stroke center over 1 academic year (July 1, 2011 to June 30, 2012). Information on the basic demographic, hospital complications, psychiatric diagnoses, and discharge disposition was collected. We identified those patients who were treated at a facility and then transferred to the tertiary center (ie, drip-and-ship paradigm). In addition to comparative and adjusted analysis to identify predictors for SM, a stratified analysis by the drip-and-ship status was performed. RESULTS: One hundred twenty patients were treated with thrombolysis for AIS included in this analysis; 20 (16.7%) were discharged with the final diagnosis of SM; 14 of those had conversion syndrome and 6 patients had other syndromes (seizures, migraine, and hypoglycemia). Patients with SM were younger (55.6 ± 15.0 versus 69.4 ± 14.9, P = .0003) and more likely to harbor psychiatric diagnoses (45% versus 9%; P ≤ .0001). Eighteen of 20 SM patients (90%) had the drip-and-ship treatment paradigm compared with 65% of those with AIS (P = .02). None of the SM had hemorrhagic complications, and all were discharged to home. Predictors of SM on adjusted analysis included the drip-and-ship paradigm (odds ratio [OR] 12.8, 95% confidence interval [CI] 1.78, 92.1) and history of any psychiatric illness (OR 12.08; 95% CI 3.14, 46.4). Eighteen of 83 drip-and-ship patients (21.7%) were diagnosed with SM compared with 2 of 37 patients (5.4%) presented directly to the hub hospital (P = .02). CONCLUSION: The drip-and-ship paradigm and any psychiatric history predict the diagnosis of SM. None of the SM had thrombolysis-related complications, and all were discharged to home. These findings may explain the superior outcomes associated with the drip-and-ship paradigm in the treatment for AIS.


Assuntos
Fibrinolíticos/administração & dosagem , Transferência de Pacientes , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Procedimentos Desnecessários , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Missouri , Alta do Paciente , Valor Preditivo dos Testes , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Centros de Atenção Terciária , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Procedimentos Desnecessários/efeitos adversos
4.
J Indian Prosthodont Soc ; 23(2): 178-183, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37102544

RESUMO

Aim: The study aimed to evaluate and compare the shear bond strength (SBS) at the interface of monolithic zirconia with zirconomer (Zr) core build-up, a new type of glass ionomer cement to monolithic zirconia with composite resin core build-up material. Setting and Design: In vitro a comparative study. Materials and Methods: A total of 32 disk-shaped samples of monolithic zirconia and two distinct core build-up materials: Zr (n = 16) and composite resin (n = 16) were used. The two components, monolithic zirconia with Zr core build-up and monolithic zirconia with composite resin core build-up, were bonded using zirconia primer and self-adhesive, dual-cure cement. The samples were subsequently thermocycled, and the SBS was tested at their interfaces. The failure modes were determined using a stereomicroscope. Data were evaluated using the descriptive analysis for mean, standard deviation, confidence interval, and independent t-test for intergroup comparison. Statistical Analysis Used: Descriptive analysis, independent t-test, Chi-square test. Results: The mean SBS (megapascals) of monolithic zirconia to Zr core build-up (0.74) was statistically significant when compared to monolithic zirconia with composite resin core build-up material (7.25) (P ≤ 0.001). Zirconomer core build-up showed 100% adhesive failure; composite resin core build-up had 43.8% cohesive, 31.2% mixed, and 25.0% adhesive failures. Conclusion: When evaluating the two core build-up materials' bindings to monolithic zirconia, Zr and composite resin core build-up showed statistically significant differences. Although Zr has been demonstrated to be the optimal core build-up material; however, additional investigation is required to determine how it bonds to monolithic zirconia more effectively.


Assuntos
Colagem Dentária , Cimentos de Resina , Cimentos de Resina/química , Teste de Materiais , Propriedades de Superfície , Resinas Compostas/química
5.
J Neurol Surg B Skull Base ; 84(6): 560-566, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37854536

RESUMO

Objectives Few studies have assessed the role of socioeconomic health care disparities in skull base pathologies. We compared the clinical history and outcomes of pituitary tumors at private and public hospitals to delineate whether health care disparities exist in pituitary tumor surgery. Methods We reviewed the records of patients who underwent transsphenoidal pituitary tumor resection at NYU Langone Health and Bellevue Hospital. Seventy-two consecutive patients were identified from each hospital. The primary outcome was time-to-surgery from initial recommendation. Secondary outcomes included postoperative diabetes insipidus, cerebrospinal fluid (CSF) leak, and gross total resection. Results Of 144 patients, 23 (32%) public hospital patients and 24 (33%) private hospital patients had functional adenomas ( p = 0.29). Mean ages for public and private hospital patients were 46.5 and 51.1 years, respectively ( p = 0.06). Private hospital patients more often identified as white ( p < 0.001), spoke English ( p < 0.001), and had private insurance ( p < 0.001). The average time-to-surgery for public and private hospital patients were 46.2 and 34.8 days, respectively ( p = 0.39). No statistically significant differences were found in symptom duration, tumor size, reoperation, CSF leak, or postoperative length of stay; however, public hospital patients more frequently required emergency surgery ( p = 0.03), developed transient diabetes insipidus ( p = 0.02), and underwent subtotal resection ( p = 0.04). Conclusion Significant socioeconomic differences exist among patients undergoing pituitary surgery at our institution's hospitals. Public hospital patients more often required emergency surgery, developed diabetes insipidus, and underwent subtotal tumor resection. Identifying these differences is an imperative initial step in improving the care of our patients.

6.
Muscle Nerve ; 46(2): 282-6, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22806380

RESUMO

INTRODUCTION: Immune-mediated myopathies are a heterogeneous group of chronic autoimmune disorders. Autoantibodies associated with this disease complex are classified into myositis-associated and myositis-specific. Anti-tRNA synthetase antibodies are the most well known of the myositis-specific antibodies. Previous reports have revealed an association of tRNA synthetase autoantibodies with systemic connective tissue disorders. METHODS: Our case report involved a 49-year-old man who developed difficulty walking and climbing stairs 5 months prior to his initial visit. No rash or skin changes were observed. RESULTS: Laboratory testing was positive for anti-PL12 autoantibody with a negative evaluation for connective tissue disorder (CTD). The patient was found to have necrotizing myopathy associated with anti-PL12 antibodies in the absence of inflammatory changes on biopsy, significant derangement of muscle enzymes, or findings characteristic of a typical CTD. CONCLUSION: A high index of suspicion must be maintained for immune-mediated necrotizing myopathy despite the absence of an identifiable CTD and milder symptoms.


Assuntos
Autoanticorpos/imunologia , Doenças Autoimunes/imunologia , Miosite/imunologia , Doenças Autoimunes/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Miosite/patologia
7.
J Clin Endocrinol Metab ; 107(11): 3162-3174, 2022 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-36036941

RESUMO

Cushing syndrome results from supraphysiological exposure to glucocorticoids and is associated with significant morbidity and mortality. The pathogenesis includes administration of corticosteroids (exogenous Cushing syndrome) or autonomous cortisol overproduction, whether or not ACTH-dependent (endogenous Cushing syndrome). An early diagnosis of Cushing syndrome is warranted; however, in clinical practice, it is very challenging partly because of resemblance with other common conditions (ie, pseudo-Cushing syndrome). Initial workup should start with excluding local and systemic corticosteroid use. First-line screening tests including the 1-mg dexamethasone suppression test, 24-hour urinary free cortisol excretion, and late-night salivary cortisol measurement should be performed to screen for endogenous Cushing syndrome. Scalp-hair cortisol/cortisone analysis helps in the assessment of long-term glucocorticoid exposure as well as in detection of transient periods of hypercortisolism as observed in cyclical Cushing syndrome. Interpretation of results can be difficult because of individual patient characteristics and hence requires awareness of test limitations. Once endogenous Cushing syndrome is established, measurement of plasma ACTH concentrations differentiates between ACTH-dependent (80%-85%) or ACTH-independent (15%-20%) causes. Further assessment with different imaging modalities and dynamic biochemical testing including bilateral inferior petrosal sinus sampling helps further pinpoint the cause of Cushing's syndrome. In this issue of "Approach to the patient," the diagnostic workup of Cushing syndrome is discussed with answering the questions when to screen, how to screen, and how to differentiate the different causes. In this respect, the latest developments in biochemical and imaging techniques are discussed as well.


Assuntos
Síndrome de Cushing , Humanos , Síndrome de Cushing/complicações , Hidrocortisona , Amostragem do Seio Petroso/efeitos adversos , Glucocorticoides , Diagnóstico Diferencial
8.
Transgend Health ; 6(2): 64-73, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34414264

RESUMO

Purpose: High levels of human immunodeficiency virus (HIV) prevalence and inconsistent condom use among transgender women in India highlight the need for additional effective HIV prevention methods like preexposure prophylaxis (PrEP). We examined the extent of and factors influencing willingness to use PrEP among trans women in India. Methods: Between June and August 2017, we conducted a cross-sectional survey among 360 trans women recruited through community-based organizations in six cities. We assessed PrEP knowledge, condom use, attitudes toward PrEP (after providing information on PrEP), preferences in PrEP pricing and access venues, discrimination experiences, and the likelihood of using PrEP. Logistic regression analyses were conducted. Results: Participants' median age was 26 years; 50.7% had not completed high school, and 24.8% engaged in sex work. Only 17.1% reported having heard of PrEP before the survey, and 80.6% reported that they would definitely use PrEP. Trans women in sex work had 28 times higher odds of reporting willingness to use PrEP than those not in sex work (adjusted odds ratio [aOR]=28.9, 95% confidence interval [CI]=8.79-95.16, p<0.001). When compared with trans women who did not experience discrimination, the odds of reporting willingness to use PrEP was lower among trans women who had experienced discrimination from health care providers (aOR=0.25, 95% CI=0.06-0.97, p=0.04) and family members (aOR=0.08, 95% CI=0.05-0.14, p<0.001). Conclusion: Willingness to use PrEP was high among trans women, especially those in sex work, despite identified barriers (e.g., discrimination experiences). To promote PrEP uptake among at-risk trans women, the steps needed are as follows: increasing awareness about PrEP; providing easy-to-understand information on PrEP's effectiveness, side effects and interactions between PrEP and hormones; training health care providers on PrEP and cultural competency; and reducing stigmas related to PrEP use and HIV. PrEP implementation research projects to identify effective PrEP delivery strategies are urgently needed to reduce the disproportionate HIV burden among trans women in India.

9.
AIDS Res Hum Retroviruses ; 37(12): 990-993, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34652967

RESUMO

Transgenders (TGs) are highly affected by HIV with high prevalence of 3.14% in India. Since 2017, targeted preventive efforts have been initiated by the government and HIV-infected TGs are being provided the antiretroviral (ART) treatment. Information on the primary HIV drug resistance is crucial for appropriate treatment selection to curb further spread of HIV in this population. In this study, we analyzed HIV-1 pol gene sequences from 36 TGs for presence of drug resistance mutations. To our knowledge, this first study from India reports high-level primary drug resistance (13.8%) among the TG population. Mutations M184V, A98G, K103N, G190A, and Y318F associated with resistance to nucleoside reverse transcriptase inhibitor and non-nucleoside reverse transcriptase inhibitors were observed. All pol gene sequences revealed HIV-1 subtype C in all study TG. High-level HIV-1 drug resistance warrant nationwide larger studies on TGs to understand the level of primary ART drug resistance among this population.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , HIV-1 , Pessoas Transgênero , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/genética , Genótipo , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Transcriptase Reversa do HIV/genética , HIV-1/genética , Humanos , Índia , Mutação
10.
Stroke ; 41(10): 2259-64, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20829516

RESUMO

BACKGROUND AND PURPOSE: Thrombolysis for acute ischemic stroke in the elderly population is seldom administered. METHODS: In this study, we evaluated the risks of thrombolysis, including the mortality and intracerebral hemorrhage (ICH) rates in this population. A cohort of patients was identified from the National Inpatient Sample database for the years 2000-2006. Age was categorized in 2 groups, including those between 18 and 80 years and those >80 years. Multivariate logistic regression analysis was used to assess covariates associated with hospital mortality and ICH. A total of 524 997 patients were admitted for acute ischemic stroke; 143 093 (27.2%) were >80 years. A total of 7950 patients were treated with thrombolysis, of which 1659 (20.9%) were >80 years. Elderly patients received less frequent thrombolysis compared with the younger population (1.05% versus 1.72%). RESULTS: In the whole cohort, the mortality rate was higher in the older population (12.80% versus 8.99%). For those treated with thrombolysis, the mortality rate and risk of ICH were higher among those >80 years (16.9% versus 11.5%; odds ratio: 1.56 [95% CI: 1.35 to 1.82] and 5.73% versus 4.40%; odds ratio: 1.31 [95% CI: 1.03 to 1.67], respectively). Multivariate logistic regression analysis showed that the presence of ICH (odds ratio: 2.24 [95% CI: 1.89 to 2.65]) was associated with higher mortality rates but not the use of thrombolysis (odds ratio: 1.14 [95% CI: 0.98 to 1.33]). CONCLUSIONS: Despite the higher mortality rate in the older population, the use of thrombolysis does not predict death; however, the use of thrombolysis was associated with high risk of ICH.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Ativador de Plasminogênio Tecidual/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/mortalidade , Hemorragia Cerebral/etiologia , Bases de Dados Factuais , Feminino , Fibrinolíticos/efeitos adversos , Fibrinolíticos/uso terapêutico , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento
11.
Stroke ; 41(7): 1471-6, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20522817

RESUMO

BACKGROUND AND PURPOSE: To determine the hospital mortality rates associated with elective surgical clipping and endovascular coiling of unruptured intracranial aneurysms. METHODS: We identified a cohort of patients electively admitted to US hospitals with the diagnosis of unruptured intracranial aneurysm from the National Inpatient Sample database for the years 2000 through 2006. Patient demographics, hospital-associated complications, and in-hospital mortality were compared among the treatment groups. A multivariate logistic regression analysis was used to identify independent variables associated with hospital mortality. Cochrane-Armitage test was used to assess the trend of hospital use of these procedures. RESULTS: After data cleansing, 3738 (34.3%) patients had aneurysm clipping and 3498 (32.1%) had endovascular coiling. The basic demographics including age, race, and comorbidity indices were similar between the groups. The length of hospital stay was longer in the clipped population (median 4 versus 1 day; P<0.0001), incurring a higher hospital charge in the coiled population (median $42 070 versus $38 166; P<0.0001). Hospital mortality was higher in the clipped population: 60 (1.6%) versus 20 (0.57%; adjusted odds ratio 3.63; 95% CI, 1.57, 8.42). Perioperative intracerebral hemorrhage and acute ischemic stroke were higher in the clipped population. The rate of hospital use of the endovascular coiling has increased over the years included in this study (<0.0001). CONCLUSIONS: Elective coiling of unruptured intracranial aneurysms is associated with fewer deaths and perioperative complications compared with elective clipping. The trend of hospital use of the coiling procedures has increased during recent years.


Assuntos
Procedimentos Cirúrgicos Eletivos/mortalidade , Mortalidade Hospitalar/tendências , Aneurisma Intracraniano/mortalidade , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/mortalidade , Procedimentos Cirúrgicos Vasculares/mortalidade , Adulto , Idoso , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/instrumentação , Embolização Terapêutica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Procedimentos Cirúrgicos Vasculares/efeitos adversos
12.
Pain Med ; 11(11): 1678-9, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21044257

RESUMO

BACKGROUND AND PURPOSE: Epidural injections are commonly utilized procedure in pain clinics; these procedures are not without complications. We present a rare air entrapment within the substance of the spinal cord causing symptoms of myelopathy. METHODS: Report of a case. RESULTS: A 56-year-old woman with chronic cervical pain underwent an elective cervical epidural injection. A small amount of Lidocaine was injected at the left cervical 7 to test needle patency; she immediately complained of severe cervical pain radiated to the left upper and lower extremities. The procedure was immediately terminated and needle was removed. Post-operative neurological examination revealed mild left lower extremity weakness and left hemiataxia. An immediate MRI of the cervical spine showed an air bubble within the cervical spinal cord that has resolved on the following imaging. The clinical syndrome also completely resolved. CONCLUSION: Although rare, epidural cervical injection can be complicated by air myelopathy.


Assuntos
Embolia Aérea/etiologia , Injeções Epidurais/efeitos adversos , Cervicalgia/tratamento farmacológico , Doenças da Medula Espinal/etiologia , Medula Espinal/patologia , Feminino , Humanos , Pessoa de Meia-Idade
13.
Pain Med ; 11(10): 1516-24, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21199304

RESUMO

BACKGROUND: Despite new guidelines and nationally mandated regular assessments, managing pain in cognitively impaired patients remains a complex and challenging task. Numerous studies have focused on assessing pain in this population; however, studies of treatment are limited. PURPOSE: The purpose of this article was to characterize assessment and pain management strategies used by providers caring for hospitalized cognitively impaired patients with acute pain, and to assess for associations between amount of opioid received and specific adverse outcomes in this patient population. METHODS: Medical records of patients admitted to the Geriatrics Service or Orthopedic Service or evaluated by the Geriatrics Consult Service at an urban tertiary care hospital between September 01, 2006 and September 30, 2007 with cognitive impairment and an acute pain problem on admission were reviewed. RESULTS: Participants (N=100) had a mean age of 86 years (range=68-99), and were mostly female (83%) with fracture-related pain (62%). A numeric pain score was recorded in 67% of nursing assessments vs <5% of physician assessments. Opioids were prescribed for 100% of the surgical patients vs 43% of the medical patients. Only 15% of patients were placed on a standing analgesic regimen. Nonpharmacological management was employed for 75% of surgical patients vs 43% of medical patients. Delirium occurred in 27% of patients, and 33% experienced an interruption of physical therapy. Neither, however, was associated with level of opioid use. CONCLUSIONS: Current assessment and treatment practices in acute pain management for cognitively impaired patients vary widely (to include service and provider type). Implementation of evidence-based guidelines is needed to improve patient care.


Assuntos
Transtornos Cognitivos/complicações , Manejo da Dor , Idoso , Idoso de 80 Anos ou mais , Analgésicos/administração & dosagem , Analgésicos/efeitos adversos , Analgésicos/uso terapêutico , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Interpretação Estatística de Dados , Delírio/induzido quimicamente , Delírio/psicologia , Relação Dose-Resposta a Droga , Feminino , Fraturas Ósseas/complicações , Pessoal de Saúde , Hospitalização , Humanos , Masculino , Dor/complicações , Dor/psicologia , Medição da Dor/métodos , Médicos , Estudos Retrospectivos , Falha de Tratamento , Resultado do Tratamento
14.
Contemp Clin Dent ; 10(3): 428-432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-32308315

RESUMO

PURPOSE OF THE STUDY: The purpose of the study is to evaluate the efficacy of three gingival retraction systems such as polyvinyl siloxane foam retraction system (magic foam cord; Coltene/WhaledentInc), polysiloxane paste retraction system (GingiTrac; Centrix), and aluminum chloride impregnated twisted retraction cord (Stay-Put; Roeko) in endodontically treated teeth. MATERIALS AND METHODS: Patients who were endodontically treated for molars and requiring crown for the same, were selected for the present study with sample size of 45. The 45 participants were divided into three groups. Group 1 was treated with Stay-Put, Group 2 with Magic Foam, and Group 3 with GingiTrac. About 90 elastomeric impressions of the participants were taken-45 impressions before retraction and 45 impressions after retraction. The sulcus width was measured on the die obtained from the elastomeric impressions by placing the dies under OVI-200 optical microscope in combination with X soft imaging system software attached to a computer. RESULTS: The study indicated 0.465627 mm ± 0.063066 mm of gingival retraction for aluminum chloride impregnated retraction cord, 0.210993 mm ± 0.067358 mm of gingival retraction for GingiTrac paste, and 0.294147 mm ± 0.056697 mm of gingival retraction for magic foam cord. CONCLUSION: The study data indicated that the new retraction systems are not as effective as the standard retraction cord; however, of the two new systems the Magic Foam system did prove to be effective enough for clinical use. The GingiTrac system failed to achieve the minimum gingival retraction required and hence may not be suitable for clinical use.

16.
Am J Hosp Palliat Care ; 35(1): 173-183, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28273750

RESUMO

BACKGROUND: Many patients live with serious chronic or terminal illnesses. Multicomponent palliative care interventions have been increasingly utilized in patient care; however, it is unclear what is being implemented and who is delivering these interventions. OBJECTIVES: To (1) describe the delivery of multicomponent palliative care interventions, (2) characterize the disciplines delivering care, (3) identify the components being implemented, and (4) analyze whether the number of disciplines or components being implemented are associated with positive outcomes. DESIGN: Systematic review. STUDY SELECTION: English-language articles analyzing multicomponent palliative care interventions. OUTCOMES MEASURED: Delivery of palliative interventions by discipline, components of palliative care implemented, and number of positive outcomes (eg, pain, quality of life). RESULTS: Our search strategy yielded 71 articles, which detailed 64 unique multicomponent palliative care interventions. Nurses (n = 64, 88%) were most often involved in delivering care, followed by physicians (n = 43, 67%), social workers (n = 33, 52%), and chaplains (n = 19, 30%). The most common palliative care components patients received were symptom management (n = 56, 88%), psychological support/counseling (n = 52, 81%), and disease education (n = 48, 75%). Statistical analysis did not uncover an association between number of disciplines or components and positive outcomes. CONCLUSIONS: While there has been growth in multicomponent palliative care interventions over the past 3 decades, important aspects require additional study such as better inclusion of key groups (eg, chronic obstructive pulmonary disease, end-stage renal disease, minorities, older adults); incorporating core components of palliative care (eg, interdisciplinary team, integrating caregivers, providing spiritual support); and developing ways to evaluate the effectiveness of interventions that can be readily replicated and disseminated.


Assuntos
Doença Crônica/terapia , Cuidados Paliativos/organização & administração , Doente Terminal , Clero , Pessoal de Saúde/organização & administração , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Humanos , Planejamento de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Educação de Pacientes como Assunto/organização & administração , Qualidade de Vida , Religião , Assistentes Sociais
17.
J Int AIDS Soc ; 19(3 Suppl 2): 20809, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27431474

RESUMO

INTRODUCTION: Transgender populations face inequalities in access to HIV, health and social services. In addition, there is limited documentation of models for providing appropriately tailored services and social support for transgender populations in low- and middle-income countries. This paper presents outcomes of the Global Fund-supported Pehchan programme, which aimed to strengthen community systems and provide HIV, health, legal and social services to transgender communities across 18 Indian states through a rights-based empowerment approach. METHODS: We used a pre- and post-intervention cross-sectional survey design with retrospective analysis of programmatic data. Using stratified sampling, we identified 268 transgender participants in six Indian states from a total of 48,280 transgender people served by Pehchan through 186 community-based organizations. We quantified the impact of interventions by comparing baseline and end line indicators of accessed health social and legal services. We also assessed end line self-efficacy and collective action with regard to social support networks. RESULTS: There were significant increases in community-based demand and use of tailored health, legal, social and psychological services over the time of the Pehchan programme. We report significant increases in access to condoms (12.5%, p<0.001) and condom use at last anal sex with both regular (18.1%, p<0.001) and casual (8.1%, p<0.001) male partners. Access to HIV outreach education and testing and counselling services significantly increased (20.10%, p<0.001; 33.7%, p<0.001). In addition, significant increases in access to emergency crisis response (19.7%, p<0.001), legal support (26.8%, p<0.001) and mental health services (33.0%, p<0.001) were identified. Finally, we note that the Pehchan programme successfully provided a platform for the formation, collectivization and visibility of peer support groups. CONCLUSIONS: The Pehchan programme's community involvement, rights-based collectivization and gender-affirming approaches significantly improved both demand and access to tailored HIV, health and social services for transgender individuals across India. Furthermore, the Pehchan programme successfully fostered both self-efficacy and collective identity and served as a model for addressing the unique health needs of transgender communities. Continued strengthening of health, social and community systems to better respond to the unique needs of transgender communities is needed in order to sustain these gains.


Assuntos
Acessibilidade aos Serviços de Saúde , Programas Nacionais de Saúde , Pessoas Transgênero , Adulto , Preservativos/estatística & dados numéricos , Estudos Transversais , Feminino , Identidade de Gênero , Infecções por HIV/prevenção & controle , Infecções por HIV/terapia , Humanos , Índia , Masculino , Transtornos Mentais/terapia , Estudos Retrospectivos , Sexo Seguro/estatística & dados numéricos , Comportamento Sexual , Parceiros Sexuais , Apoio Social , Fatores Socioeconômicos , Pessoas Transgênero/psicologia
18.
Clin Interv Aging ; 11: 1325-1332, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27713623

RESUMO

OBJECTIVES: Although postdischarge outpatient follow-up appointments after a hospitalization for heart failure represent a potentially effective strategy to prevent heart failure readmissions, patterns of scheduled follow-up appointments upon discharge are poorly described. We aimed to characterize real-world patterns of scheduled follow-up appointments among adult patients with heart failure upon hospital discharge. PATIENTS AND METHODS: This was a retrospective cohort study performed at a large urban academic center in the United States among adults hospitalized with a principal diagnosis of congestive heart failure between January 1, 2013, and December 31, 2014. Patient demographics, administrative data, clinical parameters, echocardiographic indices, and scheduled postdischarge outpatient follow-up appointments were collected. RESULTS: Of the 796 patients hospitalized for heart failure, just over half of the cohort had a scheduled follow-up appointment upon discharge. Follow-up appointments were less likely among patients who were white and had heart failure with preserved ejection fraction and more likely among patients with Medicaid and chronic obstructive pulmonary disease. In an adjusted multivariable regression model, age ≥65 years was inversely associated with a scheduled follow-up appointment upon hospital discharge, despite higher rates of several cardiovascular and noncardiovascular comorbidities. CONCLUSION: Just half of the patients discharged home following a hospitalization for heart failure had a follow-up appointment scheduled, representing a missed opportunity to provide a recommended care transition intervention. Despite a greater burden of both cardiovascular and noncardiovascular comorbidities, older adults (age ≥65 years) were less likely to have a follow-up appointment scheduled upon discharge compared with younger adults, revealing a disparity that warrants further investigation.


Assuntos
Agendamento de Consultas , Insuficiência Cardíaca/epidemiologia , Cooperação do Paciente/estatística & dados numéricos , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pacientes Ambulatoriais , Estudos Retrospectivos , Estados Unidos
19.
Interv Neurol ; 4(3-4): 75-82, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27051402

RESUMO

Mechanical thrombectomy using retrievable stents or stent retriever devices has become the mainstay of intra-arterial therapy for acute ischemic stroke. The recent publication of a series of positive trials supporting intra-arterial therapy as standard of care for the treatment of large vessel occlusion will likely further increase stent retriever use. Rarely, premature stent detachment during thrombectomy may be encountered. In our multicenter case series, we found a rate of detachment of less than 1% (n = 7/1,067), and all were first-generation Solitaire FR devices. A review of the US Food and Drug Administration database of device experience yielded 90 individual adverse reports of detachment. There were 82, 1 and 7 detachments of Solitaire FR (first generation), Solitaire FR2 (second generation) and Trevo devices, respectively. We conclude with a brief overview of the technical and procedural considerations which may be helpful in avoiding this rare complication.

20.
Interv Neurol ; 3(3-4): 135-41, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26279660

RESUMO

BACKGROUND: Coil embolization of wide-neck cerebral aneurysms frequently requires stent or balloon assistance. Such approaches to coil embolization increase the procedural complexity, adding risk and cost. OBJECTIVE: To describe a series of coil embolization procedures performed using a single-balloon microcatheter to treat wide-neck aneurysms and establish the safety, feasibility and efficacy of this technique. METHODS: A retrospective review was performed to identify cases in which the Ascent balloon (Codman Neurovascular, Raynham, Mass., USA) was used as a single-balloon microcatheter for aneurysm coil embolization at two institutions. Clinical, demographic and angiographic data were obtained, and aneurysm volumes as well as packing densities (PD) were calculated. RESULTS: Eight cerebral aneurysms were treated using this technique. Six of these were unruptured. The aneurysms had an average neck diameter of 3.7 mm, and the maximum dimension ranged from 5 to 11 mm, with a mean of 7.5 mm. The mean aspect ratio was 2.07. The mean volume of the aneurysms was 180.38 mm(3). The average PD achieved in these 8 aneurysms was 41.79%. Complete occlusion with coil embolization [Raymond-Roy Occlusion Classification (RROC) 1] was achieved in all cases except one, where a small residual was left deliberately and the occlusion grade was RROC 2. There were no intraprocedural complications. CONCLUSION: This initial experience demonstrates the feasibility and immediate outcomes of a single-balloon microcatheter technique in coil embolization of wide-neck cerebral aneurysms. This technique may be used to achieve a high PD, comparable to that obtained with stent-assisted coiling or coiling alone, while avoiding permanent stent placement and potentially reducing thromboembolic complications.

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