Salivary Cortisol and Anxiety in Canadian Dentists over 1 Year of COVID-19.

The dental profession has endured unprecedented disruption amid COVID-19. Novel stressors have included a high risk of occupational exposure to COVID-19, financial losses, and stricter infection prevention and control requirements. The present study investigated the longitudinal impact of COVID-19 on the stress and anxiety levels of a cohort of Canadian dentists (N = 222) between September 2020 and October 2021. Salivary cortisol was selected as a biomarker of mental stress, and 10 sets of monthly saliva samples (2,131 in total) were self-collected, sent to our laboratory in prepaid courier envelopes, and analyzed by enzyme-linked immunosorbent assay. To assess COVID-19 anxiety, 9 monthly online questionnaires were administered, comprising a general COVID-19 anxiety instrument and 3 items regarding the impact of dentistry-related factors. Bayesian log-normal mixed effect models were fitted to estimate the longitudinal trajectory of salivary cortisol levels and their association with the disease burden of COVID-19 in Canada. After accounting for age, sex, vaccination status, and the diurnal rhythm of cortisol secretion, a modest positive association was found between dentists' salivary cortisol levels and the count of COVID-19 cases in Canada (96% posterior probability). Similarly, the self-reported impact of dentistry-related factors, such as fear of getting COVID-19 from a patient or coworker, was greatest during peaks of COVID-19 waves in Canada; however, general COVID-19 anxiety decreased consistently throughout the study period. Interestingly, at all collection points, the majority of participants were not concerned about personal protective equipment. Overall, participants reported relatively low rates of psychological distress symptoms in relation to COVID-19, a result that should be reassuring for the dental community. Our findings strongly suggest a link between self-reported and biochemical measurements of stress and anxiety in Canadian dentists during the COVID-19 pandemic.

[Biological glue does not reduce lymphorrhoea after lymph node excision. Randomized prospective study on 40 patients]. / La colle biologique ne réduit pas la lymphorrhée après curage axillaire. Etude prospective randomisée sur 40 patientes.

The aim of this prospective and randomized study, was to demonstrate the benefit by using fibrin glue after axillary lymph node dissection. From January 1990 to January 1991, forty females were randomized before surgery for breast cancer: 20 patients of the group A underwent additional application of fibrin glue (5 ml containing 500 IU of thrombin) by spray only in the area of axillary dissection, while the 20 patients of group B acted as the control group. The two groups were compared for age, number of nodes removed and involved, drainage volume and duration and complications. Student's t test, Mann and Whitney non parametric test and chi 2 were used when appropriate for statistical analysis. The two groups were well balanced for age, number of nodes removed and involved, staging and histologic findings. The average volume of lymphorrhoea in the lymph node dissection area was greater after use of fibrin glue (410.4 ml) than in controls (275.5 ml, p = 0.016). No difference was noted between the two groups for the volume of drainage of the mastectomy or lumpectomy site or, for the total volume of drainage. Drainage durations as well as hospital stay were similar. Six complications occurred in group A, and one in group B (p = 0.037).(ABSTRACT TRUNCATED AT 250 WORDS)

[Mini-forum: rhinoplasty by external approach. Collumello-trans-alar approach of open rhinoplasty: advantages]. / Mini forum: rhinoplastie par voie externe. La voie columello-transalaire derhinoplastie à ciel ouvert: avantages.

For several years, the authors have been using a columellar transalar incision through the medial crus along the nasal septum, reaching the vault and continued laterally by a transalar cartilaginous incision. The nasal tip is thus opened like a car-hood, leaving the alar cartilage attached to the skin and exposing the triangular cartilage and the nasal septum. This approach allows septoplasty to be performed with excellent exposure. The tip is easily revised backwards allowing anomalies to be viewed directly. The advantages of this external approach compared with the classical external Rethi's approach are multiple: simplicity and rapidity of the technique, excellent access to triangular cartilages and the triangular-septum junction; possibility of always going from an endonasal approach to an external one and excellent access to the tip. Moreover, there is no long term swelling of the tip. The indications of this external approach are asymmetry of the tip, excessive tip projection, saddle nose deformities and secondary rhinoplasties. No complication has been observed in a series of 32 patients with a follow-up of 6 to 48 months. There is no disturbance of the tip position and the skin scar is imperceptible.

Penetration of roxithromycin into gingival tissue.

Roxithromycin is a new macrolide with an antibacterial spectrum similar to that of erythromycin. Absorption is rapid and complete, resulting in high serum levels and a long half-life. Tissue distribution is extensive and sustained, as shown by the high concentrations measured in the lung, prostate, ovaries, liver, kidney, and skin. In this study, we measured the penetration of roxithromycin into gingival tissue at steady state in 30 patients treated orally with 150 mg every 12 hr for 5 days. Tissue specimens were sampled at 2, 4, 6, 8, or 12 hr (n = 6 each time) after dose 10, and blood samples were taken simultaneously. Serum and tissue concentrations of roxithromycin were measured by high-performance liquid chromatography. The peak serum level, reached 4 hr after dosing, was 6.60 +/- 1.15 micrograms/ml. The peak tissue level was 4.63 +/- 1.84 micrograms/g and was reached after 8 hr. From 4 to 10 hr after dosing, tissue concentrations were greater than 2 micrograms/g, that is, higher than the MIC90 of roxithromycin against most oral pathogens. These data support the use of roxithromycin in the treatment of oral infections.

[Diffusion of roxithromycin in gingival tissue]. / Diffusion gingivale de la roxithromycine.

The gingival penetration of roxithromycin was evaluated at steady-state in twenty nine patients treated by 150 mg orally every 12 h during five days. Tissue specimen were sampled at 2 h (n = 6), 4 h (n = 6), 6 h (n = 5), 8 h (n = 6) and 12 h (n = 6) after the 10th administration. One blood sample was drawn at the same times. Serum and tissue concentrations of roxithromycin were measured by high performance liquid chromatography (HPLC). Serum peak level, measured at the 4th h, reached 6.60 +/- 1.15 micrograms/ml. The tissue peak concentration was 4.63 +/- 1.84 micrograms/g at the 8th h. Between the 4th and 10th hour after administration, the tissue concentrations are above 2 micrograms/g, i.e. above roxithromycin MIC 90 against most of the encountered pathogens in stomatologic infections.

Marketing imperatives for hospice and hospitals: implications of hospice headway.

This study reports physician perceptions of the administrative fluency of hospice programming and the comparative service qualities of hospice and acute care hospitals on 11 care needs of the terminally ill. Hospice programs evidence organizational sophistication levels which belie their institutional youth. Hospice had a clear advantage within our stacked comparison of care delivery for the terminally ill. Supporting our model of organizational adaptation, however, the performance gap was smallest on those attributes physicians rate as most important to the terminally ill. Finally, hospice referral rates are statistically explained more by administrative prowess than perceived advantages in care delivery. This compels hospital and hospice attention to informational and relational marketing to physicians.

Diagnosing the physician as gatekeeper in hospice marketing.

The attitudes and opinions gatekeeping physicians hold toward hospice are important in critically evaluating hospice marketing efforts. Based on a national sample of physicians, this article examines their perceived role in the referral process and their evaluation of critical care components, hospice administration, and communication vehicles. Recommendations for future marketing efforts are offered.

Trimethoprim in the treatment of urinary infections in hospital.

Success in the cure of urinary infections of hospital patients was compared for five-day courses of sulphamethoxazole alone, sulphamethoxazole plus one-tenth its weight of trimethoprim, and sulphamethoxazole plus one-fifth its weight of trimethoprim (Septrin). The cure rates were 65%, 84%, and 92% respectively. Fifty-four per cent. of 111 patients had urinary tract abnormalities. Forty-three per cent. of the causative organisms were sulphonamide-resistant in vitro. There were no major side-effects, though two patients had pruritus or a rash.The degree of potentiation of sulphamethoxazole activity by one-fifth the weight of trimethoprim was so great that its cure rate of infections due to sulphonamide-resistant organisms exceeded that of sulphamethoxazole alone used in infections due to sulphonamide-sensitive organisms. The degree of synergism between trimethoprim and sulphamethoxazole demonstrated in vitro against urinary organisms was directly related to the cure rate of the combination.