Comparative characteristics of older people with type 1 diabetes treated with continuous subcutaneous insulin infusion or insulin injection therapy: data from the German/Austrian DPV registry.

AIM: To compare clinical characteristics and outcomes in adults with type 1 diabetes aged ≥ 60 years using continuous subcutaneous insulin infusion (CSII) vs. insulin injection therapy. Further, to determine the percentage of older adults with type 1 diabetes using CSII. RESEARCH DESIGN AND METHODS: Retrospective study using data of the Diabetes Prospective Follow-up Registry (DPV). Including percentage CSII use from 2008 to 2018, and the characteristics of 9547 individuals extracted from the DPV in March 2019 (N = 1404 CSII; N = 8143 insulin injection therapy). Wilcoxon rank sum tests were used for continuous variables and chi-square tests for categorical variables to compare clinical characteristics of people using CSII vs. insulin injection therapy. Adjusted analyses used generalized linear models to compare diabetes-related outcomes. RESULTS: CSII usage has increased in older adults (from 12% in 2008 to 23% in 2018). After adjustment, CSII was associated with lower HbA1c [60.7 mmol/mol (7.7 ± 0.1%) vs. 62.8% (7.9 ± 0.1%)], lower daily insulin dose (0.49 ± 0.02 vs. 0.61 ± 0.01 IU/kg), fewer days in hospital (8.1 ± 0.12 vs. 11.2 ± 0.11 days/person-year), fewer severe hypoglycaemic events (0.16 ± 0.02 vs. 0.21 ± 0.03 events/person-year) and fewer diabetic ketoacidosis (0.06 ± 0.01 vs. 0.08 ± 0.01 events/person-year). Individuals on CSII showed lower rates of microalbuminuria and also have a diagnosis of depression and neuropathy. CONCLUSIONS: A growing number of older adults are using insulin pumps. Older age in itself should not be seen as a contraindication for CSII.

Effect of probiotics as a complement to non-surgical periodontal therapy in chronic periodontitis: a systematic review.

BACKGROUND: To improve the results of the classic periodontal treatment, probiotics have been suggested recently to decrease the number of bacteria and the expression of mediators of inflammation. This systematic review aimed to assess the literature for the effectiveness of different probiotic strains as adjuvants to non-surgical periodontal therapy. MATERIAL AND METHODS: The electronic database of MEDLINE (via Pubmed) was searched up to December 2017 for randomised clinical trials in English comparing non-surgical periodontal treatment and probiotics versus periodontal treatment and placebo. The primary outcome investigated was reduction in pocket probing depth. Secondary outcomes were bleeding on probing, plaque index reduction and bacteria counts. RESULTS: Nine trials were included. A narrative data synthesis did not result in any major improvement of overall pocket probing depth but moderate pockets from 4 to 6 mm showed larger reductions in study groups, which could decrease the need for surgery. Sites with bleeding on probing and presence of plaque decreased after treatment. For periimplant mucositis, there was a small tendency to better results in the study group. CONCLUSIONS: With the available data, it is concluded that probiotics may provide an additional benefit to manual debridement in chronic periodontitis. More studies are required on dose, route of administration and strains of probiotics used.

Betel and tobacco chewing habit and its relation to risk factors for periodontal disease.

OBJECTIVES: To comparatively assess periodontal status in patients who chew different products and patients who do not have this habit and to assess how this practice interacts with predisposing factors and risk indicators of disease. METHODS: Patients included in the dental care carried out in a rural community in India were considered for a cross-sectional study. The simplified oral hygiene index and the community periodontal index (CPI) were assessed. Furthermore, a validated survey with items concerning chewing habits was administered. Statistical analysis of the effects of age range, gender, chewing products and hygiene status on CPI was performed. RESULTS: In total, 1,023 patients met the inclusion criteria. The chewer patients (430) exhibited a significantly higher CPI than the non-chewers (593). The chewing habit increased the likelihood of a higher CPI by 6.76-fold, while excellent-good oral hygiene status decreased the probability of a higher CPI by approximately 45%. CPI did not differ significantly among chewers of different products. CONCLUSION: In the population studied, a chewing habit was associated with a worse periodontal status, and this association was not modified by gender and age as predisposing factors. Oral hygiene could decrease the effect of chewing habit on periodontal health.

Letter to Editor: Support to the Spanish language, from Oral Medicine.

In the form of a letter to the director, the author provides linguistic comments related to Spanish. He draws attention to some often misused words and suggests some expressions that may improve the use of the Spanish language in scientific texts.

Risk factors for oral epithelial dysplasias to become malignant: clinical implications.

There is a lack of effective clinical management of oral epithelial dysplasias to reduce their risk of malignant transformation and considerable gaps in knowledge regarding the most effective means of treating such lesions. A retrospective cohort of biopsy-confirmed oral epithelial dysplasias consecutively diagnosed in the period 1995-2014 and followed-up until 2017 was identified from pathology department files. Demographic, clinical and follow-up information was collected. Multivariate Cox proportional-hazards models were performed to evaluate sociodemographic, clinical and pathological factors associated with progression to oral squamous cell carcinoma. The study included 144 oral epithelial dysplasias, of which 42% progressed to oral cancer at the end of follow-up (21 years). Clinical aspect of the lesion was described for 77 (53.5%) of the patients. Treatment, age, grade of the lesion and diagnostic period were independent prognostic factors for progression. When considering only patients with described clinical aspect, only treatment and grade of the lesion were independently associated with cancer. The results from this non-selected retrospective cohort of oral epithelial dysplasias underscore the existing limitations of the current standard-of-care of the patients and provide novel insights on the management of these lesions with and without described clinical aspect. Well-designed, robust prospective studies, a homogenized staging system and multidisciplinary treatment guidelines are warranted.

[Aetiopathology and prevention of oropharyngeal cancer]. / Consideraciones sobre etiopatogenia y prevención del cáncer orofaríngeo.

Oropharyngeal cancer is in the sixth position of cancer incidence in the world (after colorectal, breast, prostate, bladder, and cervix uteri cancer). More than 90% of them are squamous cell carcinoma. This type of cancer can originate on the lip, oral cavity, pharynx, and larynx. The risk factors associated with oropharyngeal cancer are tobacco, alcohol, and poor oral hygiene. However, other conditions, such as infection with human papilloma virus (HPV) and oral dysbiosis, are gaining prominence. Pre-malignant and malignant lesions are related to diverse factors that can be monitored by the health professional. These professionals are also in an ideal position to influence and advise patients on healthy life habits that contribute to prevent or treat metabolic-endocrine syndromes associated with the development of pre-cancerous disease and cancer located in different organs.

Gynaecomastia in a patient with a hCG producing giant cell carcinoma of the lung. Case report.

Gynaecomastia, or enlargement of the male breast may result from various endocrine dysfunctions and often reflects ectopic production of substances such as hCG and estradiol. We report on the case of a 30 year old man who presented with gynaecomastia and elevated plasma levels of hCG, estradiol and testosterone. As a result of several diagnostic procedures such as selective venous sampling and magnetic resonance tomography (MRT), a hCG producing tumor of the upper lobe of the left lung was found. This hormonal overproduction induced an enhanced secretion of estradiol and testosterone in the testicular tissue. Histology revealed a giant cell carcinoma with positive immunostaining for hCG. This case report further underlines the necessity of an intensive search for ectopic beta-hCG production due to malignant tumours, in particular in the adult.

Intensive insulin therapy with insulin lispro in patients with type 1 diabetes reduces the frequency of hypoglycemic episodes.

In a randomized, open-label, controlled cross-over trial, 107 patients with type 1 diabetes were treated with either regular human insulin or insulin lispro, a rapid-acting insulin analogue. After a lead-in period of 2 to 4 weeks, the patients were randomized to receive intensified insulin treatment with one of the insulins. NPH-human insulin was used for basal substitution in both groups. The crossover took place after 3 months of treatment. Efficacy and safety of the drugs were established by the assessment of hemoglobin A1c, pretest blood glucose, 1 and 2-hour postprandial glucose excursions, number of hypoglycemic episodes, daily insulin doses, body weight, insulin antibodies, and the number and severity of adverse events. A questionnaire comprised of four primary domains was used to measure some quality of life aspects of the patients. Both treatment regimens were well tolerated. While no differences were seen in the hemoglobin A1c values, there was a trend for a decrease in the pretest blood glucose levels and significant decreases of the 1 and 2-hour postprandial glucose excursions in the patients treated with insulin lispro. The number of hypoglycemic episodes was also significantly lower in the insulin lispro treatment period. The evaluation of the quality of life questionnaire revealed an improvement in the patients treatment satisfaction for the insulin lispro group. During treatment with insulin lispro, the basal insulin doses increased slightly. However, the total daily insulin doses decreased to a greater extent with insulin lispro as compared to regular human insulin. Human insulin-specific antibody binding values at endpoint were not different for the two treatments. In conclusion, intensive insulin treatment with insulin lispro therapy results in improved postprandial glycemic control and HbA1c levels at least equal to the treatment with regular human insulin but with less hypoglycemia and more treatment satisfaction for the patient.

Comparison of the microvascular response to transcutaneous electrical nerve stimulation and postocclusive ischemia in the diabetic foot.

Neurogenic inflammation, mediated by unmyelinated C-nerve fibers, is part of the acute neurovascular response to injury. Laser doppler flowmetry was used to measure the flare response to transcutaneous electrical nerve stimulation (TENS) and to compare this axon reflex vasodilatation with postischemic hyperemia in the skin of the foot in diabetic and nondiabetic subjects. Twenty-one control subjects and 57 diabetic patients (25 type I; 32 type II; 14 without complications; 14 with neuropathy and without retinopathy; 8 with retinopathy and without neuropathy; 21 with neuropathy and retinopathy) were enrolled in the study. Following TENS, an increase in skin blood flow was found at the dorsum of the foot without any significant difference between the different groups. Compared to the control group, axon reflex vasodilatation was significantly reduced in the group of patients with diabetic neuropathy and in the group of patients with diabetic neuropathy and retinopathy at the pulp of the hallux (61 +/- 15 versus -6 +/- 16; versus 23 +/- 5; p < 0.05, respectively). All investigated groups exhibited a significant increase in skin blood flow after arterial occlusion without any significant difference between the groups. A good association was observed between postocclusive and TENS-induced hyperemia at the dorsum of the foot (r = 0.39; p = 0.0002), but only a weak association was found at the pulp of the hallux (r = 0.24; p = 0.03). TENS-induced hyperemia was associated with a diminished sweat response (p = 0.03), but not with pathological cardiovascular function tests (p = 0.07). Electrical axon reflex vasodilatation is diminished in diabetic patients suffering from peripheral autonomic C-fiber injury, especially in skin rich in thermoregulatory blood flow. The diminished neurovascular response is independent of vascular alterations in diabetes mellitus.

[Selective blood sampling from the inferior petrosal sinus using digital subtraction angiography]. / Selektive Blutentnahme aus dem Sinus petrosus inferior mit digitaler Subtraktionsangiographie.

Simultaneous bilateral venous sampling of blood from the inferior petrosal sinuses helps in the differentiation between peripheral and central ACTH hypersecretion. One can also locate the site of a hormonally active hypophyseal micro-adenoma that cannot be demonstrated by other methods. The authors have experience with fifteen patients and discuss the indications, technique and problems as well as the advantages of using digital subtraction angiography.

The influence of different generations of computer algorithms on diabetes control.

With all control schedules, the management of diabetes is possible using Skyler's algorithm. In general, those control algorithms which do not allow the individual adaptation to changing conditions lead to overinsulinisation. So-called meal-related algorithms do usually minimise the fluctuations in blood sugar. The introduction of self-adapting algorithms, detecting peripheral insulin resistance, may further improve metabolic diabetes control.

[Cushing syndrome in ACTH-producing neuroendocrine tumor of the hepatic duct]. / Cushing-Syndrom bei ACTH-produzierendem neuroendokrinen Tumor des Ductus hepaticus.

We present a patient with an ACTH producing neuroendocrine tumor of the hepatic bile duct which was detected by chance during abdominal surgery for Cushing's syndrome. Diagnostic strategy and surgical therapy in patients with neuroendocrine tumors are discussed. The diagnostic problems caused by combination with an endocrine function disorder like Cushing's syndrome are pointed out.

Consideraciones sobre etiopatogenia y prevención del cáncer orofaríngeo / Aetiopathology and prevention of oropharyngeal cancer

El cáncer orofaríngeo ocupa la sexta posición de incidencia mundial (después de los cánceres colorrectal, de mama, próstata, vejiga y útero); más del 90% son carcinomas de células escamosas. Puede originarse en el labio, en la cavidad oral, en la faringe y en la laringe. Son bien conocidos factores de riesgo como el tabaco, el alcohol y la mala higiene bucal; sin embargo, parecen ganar protagonismo las infecciones por virus del papiloma humano (VPH) y la disbiosis oral. Las lesiones cancerizables obedecen a gran variedad de factores, cuyo control entra en el ámbito de actuación del profesional. Aparte de controlar los factores locales, la posición del profesional de la salud es idónea para aconsejar al paciente respecto a hábitos saludables de vida que contribuyan a prevenir o tratar síndromes metabólico-endocrinos, por otra parte favorecedores de patología precancerosa y cancerosa en diversas ubicaciones orgánicas

Oropharyngeal cancer is in the sixth position of cancer incidence in the world (after colorectal, breast, prostate, bladder, and cervix uteri cancer). More than 90% of them are squamous cell carcinoma. This type of cancer can originate on the lip, oral cavity, pharynx, and larynx. The risk factors associated with oropharyngeal cancer are tobacco, alcohol, and poor oral hygiene. However, other conditions, such as infection with human papilloma virus (HPV) and oral dysbiosis, are gaining prominence. Pre-malignant and malignant lesions are related to diverse factors that can be monitored by the health professional. These professionals are also in an ideal position to influence and advise patients on healthy life habits that contribute to prevent or treat metabolic-endocrine syndromes associated with the development of pre-cancerous disease and cancer located in different organs

Nivel de mercurio en cabello de niños peruanos expuestos en una zona minera de Arequipa y de la ciudad de Lima / Level of mercury in hair of peruvian children exposed in a mining area of Arequipa and Lima city

Objetivo: El propósito del estudio fue comparar los niveles de mercurio en cabello en dos muestras de niños peruanos provenientes de dos zonas geográficas distintas: una zona rural minera y una zona urbana. Material y métodos: La zona minera correspondió al poblado de Mollehuaca (Arequipa), de donde se obtuvieron 52 muestras de cabello; la zona urbana no expuesta a minería correspondió al distrito de Los Olivos (Lima), de donde se obtuvieron 40 muestras. Se determinó el nivel de mercurio con la técnica estandarizada de plasma de inducción acoplado con un espectrómetro de masas (ICP-MS). Resultados: En la zona rural, en promedio, se obtuvo un nivel de mercurio de 7,47 ppb ± 26,9. En la zona urbana, el nivel de mercurio alcanzó un promedio de 2,47 ppb ± 1,28. No se encontraron diferencias significativas en el nivel de mercurio según edad o género. Conclusión: Se concluye que el grupo expuesto a minería aurífera informal y de zona rural presentó niveles de mercurio en cabello en promedio mayores a los del grupo de zona urbana, pero esta diferencia no fue significativa (p=0,188, alfa=0,05)

Objective: The aim of this study is to compare the mercury levels tested in two groups of children from different locations from Peru: a mining countryside and a metropolitan area. Methods: The rural area was Mollehuaca (Arequipa), where children are exposed to mercury by artisanal mining. Fifty-two hair samples from children from the rural area were obtained. The urban area was District of Olives (Lima), where there is not mercury exposure by mining. Forty hair samples from children from the urban area were obtained. Mercury level was determined by induction coupled plasma mass spectrometer (ICP-MS) standard technique. Results: In the rural area, an average of level of mercury 7.47 ppb ± 26.9 was obtained; in urban areas the mercury level reached an average of 2.47 ppb±1.28. Not significant differences in the level of mercury according to age or gender were found. Conclusion: It is concluded that the group exposed to rural and informal gold mining presented an average of mercury levels in hair higher than those of the urban group, but this difference was not significant (p=0.188, alfa=0.05)

Response to topical clonazepam in patients with burning mouth syndrome: a clinical study.

Burning Mouth Syndrome (BMS) is a difficult disease for patients and clinicians. Moreover, there is not a general consensus on how to treat the disease. The main objective of this paper is to evaluate BMS patients' response to topical clonazepam treatment. A double blind study was performed. Among a total of 66 patients, 33 were treated with tablets of clonazepam and another 33 were treated with a placebo. Symptoms were evaluated after 1 month and 6 months of treatment and scored on an analogical scale from 0 to 10. Among the 33 patients treated with clonazepam, 23 showed at least a 50% reduction in symptoms after 1 month of treatment. On the contrary, only 4 in the placebo group exhibited significant improvement. After 6 months, significant differences were observed again, as 23 of the 33 patients treated with the drug reported at least a 50% reduction in symptoms, whereas only 2 among those treated with the placebo significantly improved. However, when measured in terms of a complete cure (lack of symptoms), the differences were not significant: 5 drug-treated patients and one belonging to the placebo group were asymptomatic after one month of treatment. In summary, it seems that clonazepam applied topically was effective in treating BMS in a large proportion of patients.

Boca seca y boca ardiente / Dry mouth and burning mouth

La saliva es esencial para mantener la salud oral. El 99% de su composición es agua. El desencadenante más común de boca seca es la toma de medicamentos, generalmente acompañada de escasa ingesta de líquidos. Entre sus complicaciones cabe destacar xerostomía, disgeusia y ardor bucal, entre otras. Estos síntomas son tríada frecuente del síndrome de boca ardiente (SBA). Su etiología es imprecisa y multifactorial, sin datos clínicos o de laboratorio específicos. En su patogenia intervienen factores locales, sistémicos y psicológicos. Es común la asociación de hábitos parafuncionales evidentes, dentarios y linguales, con repercusión en tejidos duros (desgaste, ATM) y blandos (lesiones facticias, irritación de papilas linguales). Afecta más a mujeres en edad perimenopáusica, en proporción hasta 7:1 respecto a los hombres. A menudo se asocian ansiedad o depresión. En este trabajo se propone la parafunción deglutoria como parte integrante del síndrome (AU)

Saliva is essential to maintain the oral health. 99% of its composition is water. The most common trigger of dry mouth is taking medication, usually accompanied with low fluid intake. Its complications include xerostomia, dysgeusia and burning mouth, among others. These symptoms are a common triad of burning mouth syndrome (BMS). Its etiology is multifactorial, vague and without specific clinical or laboratorial data. In its pathogenesis are involved local, systemic and psychological factors. As common associations are evident dental and lingual parafunctional habits, with impact on hard tissues (dental wear, TMJ) and soft tissues (factitious injury, irritation of tongue papillae). BMS affects more women in perimenopausal age, in proportion up to 7:1 compared to men. Often anxiety or depression are associated. In this work the swallowing parafunction as part of the syndrome is discussed (AU)

Probable keratocyst in a mandible from the late Roman era.

Odontogenic keratocysts, characterized by considerable local aggressiveness and high recurrence rates, account for 5-15% of all odontogenic cysts. This paper reviews the literature and describes the most important aspects of this type of cyst, a clinical example being given as way of illustration. We also report a paleopathological case featuring an osteolytic lesion where the characteristics are consistent with a keratocyst. The aim is thus to encourage odontologists to contribute to research in the field of paleopathology.

Estado periodontal y de la mucosa oral en un grupo de embarazadas: Estudio clínico / Periodontal and mucosal status in a group of pregnant women: Clinical study

Introducción: Los cambios hormonales en el embarazo se reflejan en la salud periodontal de las pacientes, se pretende cuantificar y evaluar estos cambios en la cavidad oral de 165 pacientes embarazadas, así como el estado de su mucosa oral y relacionar su percepción de salud oral con los resultados de su estado periodontal. Métodos: Pacientes de revisión de rutina de un centro de atención primaria. Se les realiza una exploración donde se evalúa el estado periodontal, mediante el Índice de Necesidad de Tratamiento Periodontal de la Comunidad (C.P.I.T.N.), y el estado de las mucosas. Los dientes escogidos para el sondaje fueron el 16, 11, 26, 36, 31 y 46 de cada paciente y se tomó como valor representativo el más alto de todos los sextantes. 56 acudieron para realizarse una reevaluación. Resultados: De las 165 embarazadas el 5% (9) fueron consideradas invalorables. El 35% dieron como resultado valor 0 (57); el 46% valor 1 (76); el 12% valor 2 (20); y el 2% valor 3 (1). De las 56 que acudieron a la reevaluación el 23% (13) mejoraron, el 10% (6) empeoraron y el 66% (37) se mantuvieron. De las 165 sólo una presentó una lesión en mucosas, una ránula. Conclusiones: Aunque hubo un porcentaje sin patología periodontal, 35%, la mayoría padecía gingivitis(46%) y algunas periodontitis (14%). Por tanto consideramos importante recomendar a las pacientes embarazadas una exploración bucodental y realizar una labor preventiva en todas las pacientes en edad fértil con el fin de evitar consecuencias negativas (AU)

Background: The hormonal changes during pregnancy are reflected in the periodontal health, the aim of this study is to evaluate and quantify these changes in the oral cavity of 165 patients as well as their mucosal status and to compare the perception pregnant women have of their own oral health and the obtained results of their periodontal status. Methods: Patients included in the study were selected from the routine dental revision program of a public health centre. An oral exploration was performed. Periodontal status was evaluated by means of the Community Periodontal Index of Treatment Needs (CPITN). Teeth 16, 11, 26, 36, 31 and 46 from each patient were proben and the chosen value was the highest one of all sextants. 56 patients came back for reevaluation. The status of the oral mucosa was also inspected. Results: Among the 165 patients, the 5% were considered non-valuable (9), the 35% scored value 0 (57), the 46% scored value 1 (76), the 12% value 2 (20) and the 2% value 3 (1). Among the 56 who came back for reevaluation 13 of them did improve (23%), 6 got worse (10%) and 37 (66%) maintained. Only one person had an oral lesion: a ranula. Conclusions: Despite there was a group free of periodontal pathology, 35%, the majority of the patients (46%) had gingivitis and some of them periodontitis (14%). It is important for us to recommend the pregnant patients to come for a buccal exploration as well as carrying out a preventive labour in all patients in fertile age (AU)