RESUMEN
BACKGROUND: Since its introduction in 1999, West Nile virus has rapidly become the most common arboviral infection in North America. Little is known about the long-term clinical sequelae of West Nile virus infection. METHODS: A total of 49 patients with laboratory-confirmed West Nile virus infection were identified through state-based surveillance. Stratification for disease severity was based on hospitalization during the infection episode. Assessment occurred a mean of 13 months after diagnosis. Medical records were reviewed, and a complete neurologic examination was performed. Standardized surveys for quality of life, functional ability, fatigue, and depression were performed for all subjects. An extensive battery of neuropsychological tests was performed to assess cognitive function. RESULTS: Self-reported fatigue, memory problems, extremity weakness, word-finding difficulty, and headache were common complaints. Standardized survey data confirmed an overall sense of poor physical health, fatigue, depression, and moderate-to-severe disability in 24 (49%), 24 (49%), 12 (24%), and 4 (8%) patients, respectively. New tremor was seen or reported for 10 (20%) of the patients. Neuropsychological testing showed abnormalities of motor skills, attention, and executive functions. Univariate analysis of multiple risk factors did not identify any predictors of adverse outcomes. CONCLUSIONS: Multiple somatic complaints, tremor, and abnormalities in motor skills and executive functions are common long-term problems among patients who have had West Nile virus infection. Patients with milder illness are just as likely as patients with more-severe illness to experience adverse outcomes.
Asunto(s)
Fiebre del Nilo Occidental/diagnóstico , Anciano , Depresión/diagnóstico , Fatiga/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Trastornos de la Memoria/diagnóstico , Persona de Mediana Edad , Trastornos de la Destreza Motora/diagnóstico , Debilidad Muscular/diagnóstico , Pruebas Neuropsicológicas , Vigilancia de la Población , Medición de Riesgo , Temblor/diagnóstico , Fiebre del Nilo Occidental/tratamiento farmacológico , Fiebre del Nilo Occidental/epidemiologíaRESUMEN
While immediate loading in the edentulous mandible is a well-documented procedure, there are limited scientific data on immediate loading in the partially edentulous mandible. Two-year success rates of immediate loading and conventional delayed loading of dental implants in partially dentate mandibles were compared. Patients were randomized into three groups: group A (n = 40), immediate provisionalization with nonocclusal loading; group B (n = 40), immediate provisionalization with occlusal loading; and group C (n = 37), delayed loading with single-stage surgery. Baseline and 2-year measurements included implant stability quotient, insertion torque, and peri-implant bone crest radiography. Two hundred nine implants were immediately loaded in 80 patients. The 2-year success rates were 93.3% for group B and 100% for groups A and C. Immediate provisionalization provided success rates similar to those for delayed loading only when not loaded in occlusion.
Asunto(s)
Implantes Dentales , Carga Inmediata del Implante Dental/métodos , Arcada Parcialmente Edéntula/cirugía , Mandíbula/cirugía , Proceso Alveolar/diagnóstico por imagen , Fuerza de la Mordida , Diseño de Implante Dental-Pilar , Implantación Dental Endoósea/métodos , Oclusión Dental , Prótesis Dental de Soporte Implantado , Fracaso de la Restauración Dental , Diseño de Dentadura , Reparación de la Dentadura , Dentadura Parcial Provisoria , Estudios de Seguimiento , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Oseointegración/fisiología , Estudios Prospectivos , Radiografía , Torque , Resultado del TratamientoRESUMEN
Prosthetic restoration of the anterior teeth is a major esthetic challenge. Esthetic treatment consists of creating pleasantly proportioned teeth and integrating them harmoniously into the patient's gingiva, lips, and face. The communication of clinical data to the laboratory is critical to the success of any esthetic treatment. The purpose here is to present a straightforward, efficient, and reproducible means of communicating esthetic specifications to ceramists, allowing them to work as though the patient was actually in front of them, with access to all of the major facial esthetic criteria.
Asunto(s)
Comunicación , Diseño de Prótesis Dental/instrumentación , Estética Dental , Laboratorios Odontológicos , Prescripciones , Diente Canino/anatomía & histología , Técnicos Dentales , Odontólogos , Diseño de Equipo , Estética , Cara/anatomía & histología , Humanos , Incisivo/anatomía & histología , Relaciones Interprofesionales , Registro de la Relación Maxilomandibular/instrumentación , Modelos DentalesRESUMEN
STATEMENT OF PROBLEM: Treatment options for an increasing number of completely edentulous patients using fixed restorations may be limited due to anatomical or financial constraints. PURPOSE: The purpose of this pilot study was to compare immediate loading versus conventional delayed loading of implants placed for the retention of mandibular overdentures. MATERIAL AND METHODS: Twenty-six subjects each received 3 implants placed in the symphysis area which were connected with a gold bar. In the experimental group (n=17), the 3 splinted implants were loaded 2 days after surgery; in the control group (n=9), the 3 implants were loaded 3 months after surgery using a conventional 2-stage approach. Recall appointments were scheduled every 3 months during the 2-year follow-up. The following clinical parameters were included and assessed: health of periimplant soft tissues using the bleeding index (BI), plaque index (PI), periimplant probing depth (PIPD), periimplant bone resorption as measured on panoramic radiographs, and implant stability using resonance frequency analysis (RFA). The Mann-Whitney test (alpha=.05) was used to compare each parameter in the 2 groups. RESULTS: After 2 years, no implant failure was recorded in either group. No significant difference was found between the 2 groups after 2 years with regard to BI (P=.33), PI (P=.81), PIPD (P=.61), periimplant bone resorption (P=.32), or RFA (P=.06). After 1 year, periimplant bone loss (P=.05) and PIPD (P=.005) were increased in the control group. CONCLUSIONS: Immediate loading of 3 splinted implants retaining a mandibular overdenture shortens treatment time for prosthesis insertion and shows, after 2 years, results comparable with the delayed approach.
Asunto(s)
Implantes Dentales , Análisis del Estrés Dental , Retención de Dentadura/instrumentación , Dentadura Completa Inferior , Adulto , Anciano , Diseño de Prótesis Dental , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
More frequent vital sign evaluation does not result in a statistically significant difference in survival or the number of transfers to the intensive care unit (for progression of disease) after adjusting for age, gender, duration of intravenous antibiotics and comorbid conditions.
Asunto(s)
Infecciones Comunitarias Adquiridas/enfermería , Evaluación en Enfermería/métodos , Examen Físico/métodos , Neumonía/enfermería , Adulto , Anciano , Presión Sanguínea , Temperatura Corporal , Investigación en Enfermería Clínica , Infecciones Comunitarias Adquiridas/mortalidad , Progresión de la Enfermedad , Femenino , Frecuencia Cardíaca , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Evaluación en Enfermería/normas , Evaluación de Resultado en la Atención de Salud , Alta del Paciente/estadística & datos numéricos , Examen Físico/enfermería , Neumonía/mortalidad , Valor Predictivo de las Pruebas , Respiración , Análisis de Supervivencia , Factores de TiempoRESUMEN
BACKGROUND: Bacterial spondylodiscitis is rarely caused by anaerobic organisms. We describe two patients with lumbar vertebral osteomyelitis and discitis caused by anaerobic bacteria, including an unusual occurrence after an endodontic procedure, and review the salient clinical features and outcomes of 31 previously reported cases. METHODS: Case reports and review of the literature. RESULTS: Median age at presentation was 65 years, with a male-to-female ratio of 2:1. The most common presenting symptoms were back pain, fever, and neurologic deficits. The lumbar spine was most frequently involved (43%); an equal number of cases involved contiguous extension or hematogenous spread. Causative anaerobes were recovered from disk space or vertebrae (13), blood (4), and/or soft tissue abscess and included Bacteroides species (12), Propionibacterium acnes (7), Peptococcus species (4), Peptostreptococcus species and Clostridium species (3 each), Corynebacterium diphtheroides and Fusobacterium species (2 each), and unspecified anaerobes (3). CONCLUSIONS: Apart from specific antibiotic selection, medical treatment and outcomes for anaerobic spondylodiscitis are similar to those for aerobic vertebral disk infection.