ABSTRACT
Background: Clinical standardization and calibration training is recommended to increase the reproducibility of periodontal probing, but its impact on manual periodontal probing outcomes has received little attention. This study examined the reproducibility of manual periodontal probing performed by a periodontist after completion of a comprehensive standardization and calibration training program. Methods: A newly-educated periodontist was subjected to an individualized periodontal probing standardization and calibration training program involving approximately 24 total hours of lecture, bench-top, and clinical instruction/evaluation. Satisfactory completion of each portion of the training program required ≥ 95% intra-examiner agreement within 1 mm between initial and repeat measurements, and a ≥ 90% level of exact agreement with measurements by a "gold standard" examiner. The periodontist then evaluated bleeding on probing (BOP) and performed duplicate measurements of probing depth (PD) and the distance between the cementoenamel junction and gingival margin (CEJ-GM) with a manual periodontal probe on 567 periodontal sites exhibiting ≥ 5 mm PD with BOP in 39 adults. Clinical periodontal attachment level (CAL) was calculated for each site as (PD) - (CEJ-GM). Results: Intra-examiner measurement error (the standard deviation for a single measurement) was found to be 0.21 mm for PD, 0.15 mm for CEJ-GM, and 0.26 mm for CAL. Replicate assessments of PD and CAL yielded excellent exact agreement kappa scores of 0.86 and 0.87, respectively. Greater intra-examiner measurement error was found at periodontal sites with more gingival inflammation as measured by higher BOP index scores. Conclusion: These findings demonstrate that a rigorous periodontal probing standardization and calibration training program facilitates acquisition of highly reproducible PD and CAL assessments in moderate to deep inflamed periodontal pockets with a manual periodontal probe. Similar formal hands-on training should be incorporated into dental education programs and clinical research studies to improve the diagnostic performance of manual periodontal probing of the periodontium.
ABSTRACT
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, rapidly progressive hematologic disorder involving uncontrolled immune system activation. HLH has been associated with viral infections, including human immunodeficiency virus (HIV) infections. We report a case of a critically ill 30-year-old female who was hospitalized with HIV-associated HLH, with a CD4 count of 4 cells/mL and HIV viral load of 1,842,730 copies/mL. After ruling out other potential infectious causes of HLH, antiretroviral therapy (ART) was initiated with darunavir, ritonavir, tenofovir, and emtricitabine. Within one week of initiation of ART, the patient began to improve clinically and hematologically and was stable enough for discharge from the hospital three weeks after starting therapy. This case suggests that treatment with ART in patients with HIV-associated HLH should be considered even in critically ill patients with low CD4 counts.
ABSTRACT
Myotonic dystrophy (DM) and facioscapulohumeral muscular dystrophy (FSHD) are the two most common adult muscular dystrophies and have progressive and often disabling manifestations. Higher levels of medication adherence lead to better health outcomes, especially important to patients with DM and FSHD because of their multisystem manifestations and complexity of care. However, medication adherence has not previously been studied in a large cohort of DM type 1 (DM1), DM type 2 (DM2), and FSHD patients. The purpose of our study was to survey medication adherence and disease manifestations in patients enrolled in the NIH-supported National DM and FSHD Registry. The study was completed by 110 DM1, 49 DM2, and 193 FSHD patients. Notable comorbidities were hypertension in FSHD (44 %) and DM2 (37 %), gastroesophageal reflux disease in DM1 (24 %) and DM2 (31 %) and arrhythmias (29 %) and thyroid disease (20 %) in DM1. Each group reported high levels of adherence based on regimen complexity, medication costs, health literacy, side effect profile, and their beliefs about treatment. Only dysphagia in DM1 was reported to significantly impact medication adherence. Approximately 35 % of study patients reported polypharmacy (taking 6 or more medications). Of the patients with polypharmacy, the DM1 cohort was significantly younger (mean 55.0 years) compared to DM2 (59.0 years) and FSHD (63.2 years), and had shorter disease duration (mean 26 years) compared to FSHD (26.8 years) and DM2 (34.8 years). Future research is needed to assess techniques to ease pill swallowing in DM1 and to monitor polypharmacy and potential drug interactions in DM and FSHD.