A standard set of person-centred outcomes for diabetes mellitus: results of an international and unified approach.

AIMS: To select a core list of standard outcomes for diabetes to be routinely applied internationally, including patient-reported outcomes. METHODS: We conducted a structured systematic review of outcome measures, focusing on adults with either type 1 or type 2 diabetes. This process was followed by a consensus-driven modified Delphi panel, including a multidisciplinary group of academics, health professionals and people with diabetes. External feedback to validate the set of outcome measures was sought from people with diabetes and health professionals. RESULTS: The panel identified an essential set of clinical outcomes related to diabetes control, acute events, chronic complications, health service utilisation, and survival that can be measured using routine administrative data and/or clinical records. Three instruments were recommended for annual measurement of patient-reported outcome measures: the WHO Well-Being Index for psychological well-being; the depression module of the Patient Health Questionnaire for depression; and the Problem Areas in Diabetes scale for diabetes distress. A range of factors related to demographic, diagnostic profile, lifestyle, social support and treatment of diabetes were also identified for case-mix adjustment. CONCLUSIONS: We recommend the standard set identified in this study for use in routine practice to monitor, benchmark and improve diabetes care. The inclusion of patient-reported outcomes enables people living with diabetes to report directly on their condition in a structured way.

Efficacy ozone therapy in reducing oral infection of periodontal disease: a randomized clinical trial.

Periodontal diseases are among the most common infectious diseases in the world, caused by pathogenic bacteria that trigger innate, inflammatory, and adaptive immune responses, leading to the destruction of supporting periodontal tissues and, if untreated, tooth loss. The objective of this study was to explore the efficacy of medical device that produced ozonized water (Medica S.r.l. Bologna, Italy) in the treatment of chronic periodontitis of adult patients. A randomized controlled split-mouth study was carried out in ten patients (5 men and 5 women age 42-73 mean 55 ± 7) with a diagnosis of chronic periodontitis. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The mouth has been divided into upper right and left quadrants. The upper and lower right quadrants were treated with ultrasonic scaler, the left quadrants with ultrasonic scaler with ozonated water. Ten microbiological samples were collected from upper left quadrants and 10 from upper right quadrants from each patient. Microbiological samples were collected from the sites of the patients at baseline and at the 7th day. Twenty localized chronic periodontitis sites were selected (10 in left quadrants and 10 in right quadrants). After the treatment with ozonized water, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the left quadrants respect to right ones. Our study demonstrated the efficacy of the ozonized water in the management of moderate to severe chronic periodontitis.

Technical note: surgical guide for computer-aided endodontic surgery.

INTRODUCTION: CBCT combined to intra-oral scansion are the means to build an endodontic surgical guide to perform an easier and safer access to the apex in endodontic micro-surgery. . METHODS: A 38-year-old woman presented chronic apical periodontitis, which involved the three roots of 16 that was treated by endodontic therapy several years ago elsewhere. The palatine channel was retreated, the mesio- and disto- buccal roots were instead treated with apicoectomy. A surgical template was printed by a 3D printer to obtain greater precision in the surgical access. CONCLUSIONS: Endodontic microsurgery has evolved over the years. New tools have been introduced to improve therapy, even if the basic principles have not changed. In fact, according to the literature, it is necessary to cut at least 3 mm of root to be sure of eliminating the anatomical variations and the accessory channels. Several Authors have devoted themselves to creating an endodontic surgical template, some in vitro and others in vivo. The present paper introduces a new method that allows a more conservative osteotomy and greater precision the surgical access. Further investigation are needed to test and improve the effectiveness of the treatment but this technique seems very promising because it is less invasive for the patient and simplifies the work for the dentist who can perform micro-surgery in an easier and faster way.

Oxygen-ozone therapy as adjuvant in the current emergency in SARS-COV-2 infection: a clinical study.

The aim of the multicentre study promoted by Nuova FIO is to evaluate the beneficial effects of the systemic Oxygen-Ozone (O2O3) therapy in patients suffering from SARS COV-2 disease in the early phases of the disease, before worsening, up to the need of tracheal intubation. The study is based on the rationale on that the systemic oxygen-ozone treatment could be effective, positively influencing the disease evolution and/or being able to mitigate the onset of the cytokine storm syndrome at least partially.

Managing COVID-19 within and across health systems: why we need performance intelligence to coordinate a global response.

BACKGROUND: The COVID-19 pandemic is a complex global public health crisis presenting clinical, organisational and system-wide challenges. Different research perspectives on health are needed in order to manage and monitor this crisis. Performance intelligence is an approach that emphasises the need for different research perspectives in supporting health systems' decision-makers to determine policies based on well-informed choices. In this paper, we present the viewpoint of the Innovative Training Network for Healthcare Performance Intelligence Professionals (HealthPros) on how performance intelligence can be used during and after the COVID-19 pandemic. DISCUSSION: A lack of standardised information, paired with limited discussion and alignment between countries contribute to uncertainty in decision-making in all countries. Consequently, a plethora of different non-data-driven and uncoordinated approaches to address the outbreak are noted worldwide. Comparative health system research is needed to help countries shape their response models in social care, public health, primary care, hospital care and long-term care through the different phases of the pandemic. There is a need in each phase to compare context-specific bundles of measures where the impact on health outcomes can be modelled using targeted data and advanced statistical methods. Performance intelligence can be pursued to compare data, construct indicators and identify optimal strategies. Embracing a system perspective will allow countries to take coordinated strategic decisions while mitigating the risk of system collapse.A framework for the development and implementation of performance intelligence has been outlined by the HealthPros Network and is of pertinence. Health systems need better and more timely data to govern through a pandemic-induced transition period where tensions between care needs, demand and capacity are exceptionally high worldwide. Health systems are challenged to ensure essential levels of healthcare towards all patients, including those who need routine assistance. CONCLUSION: Performance intelligence plays an essential role as part of a broader public health strategy in guiding the decisions of health system actors on the implementation of contextualised measures to tackle COVID-19 or any future epidemic as well as their effect on the health system at large. This should be based on commonly agreed-upon standardised data and fit-for-purpose indicators, making optimal use of existing health information infrastructures. The HealthPros Network can make a meaningful contribution.

Foreign body granuloma in the maxillofacial region: a case report.

Foreign bodies can penetrate in soft tissues of the maxillofacial region through injuries and cutaneous lacerations from trauma. Most commonly found bodies are glass, metal and wood. We report the case of a 50-year-old male patient who came to our maxillofacial department complaining about the presence of an intraoral nodule located in the right upper gingival mucosa. The patient reported the story of a road accident, three months earlier, falling from a scooter without the aid of a protective helmet.

Screening of periodontopathic bacteria in Italian patients affected by periodontitis.

Periodontal disease (PD) is among the most common infectious diseases in the world, caused by pathogenic bacteria that trigger innate, inflammatory, and adaptive immune responses, leading to the destruction of supporting periodontal tissues and, if untreated, tooth loss. This study included 3593 patients, of them 1963 had a complete dataset and thus were analysed: 1088 (55%) were from Northern Italy, 749 (38%) from Central and 126 (7%) from Southern. Aggregatibacter actinomycetemcomitans, Porphyromonas gengivalis, Treponema denticola, and Tannerella forsythia, Campylobacter rectus, Fusobacterium nucleatum, and total bacterial load were investigated. There was a significant difference in geographic distribution as regard A. actinomycetemcomitans (p<0.001), C. rectus (p<0.001), F. nucleatum (p<0.001) and total bacterial load (p<0.001). No differences were detected as regard gender, whereas a significant higher F. nucleatum load was observed in younger patients.

Traumatic and surgical scars: successful treatment with a 1,565nm erbium-glass NAFL combined with IPL.

Scars are a very common condition of the general population and can have a profound impact on the psyche of the patient such as low self-esteem and feelings of psychosocial isolation. Various therapeutic approaches have been proposed for improving the clinical appearance of scars. Fractional mode of ablative and non-ablative lasers has become a novel strategy for the treatment of scars. A total of 43 patients (Fitzpatrick skin type II to IV), clinically diagnosed of surgical and post-traumatic scars from January 2015 to December 2016, were treated. Each treatment comprised of several passes over the scars with different devices, using a 1.565nm scanned erbium-doped fiber NAFL and an IPL. All patients noted subjective improvement in cosmesis and functionality after treatment, also with a decreased pain and an increased mobility on the underlying plans. Numerous therapeutic strategies for traumatic and surgical scars have been suggested to date, but no consistent treatment modality has been established yet. In our study, we have shown that there was a significant collagen remodelling with decrease of scar vascularity and significant improvement of pliability of scar after combined treatment with non-ablative fractional resurfacing and IPL resulting in a remarkable improvement in scar vascularity, pigmentation and height.

A novel technique to prevent sinus membrane collapse during maxillary sinus floor augmentation without bone graft: technical note.

Different surgical techniques have been developed to reconstruct the posterior maxilla without bone graft. A barrier membrane usually placed internal to the sinus, without stabilizer or bone window, pushed inside the sinus cavity as the ''roof'' of the sinus cavity to preserve the space and help bone regeneration has been used with success. In the present technical report, the heterologous cortical lamina is used for the mechanical support of sinus membranes. The membrane is placed through two lines of 2-3 mm, mesial and distal, created at the top of the antrostomy. The half heterologous membrane is positioned on these lines and pushed to the nose wall of the sinus, and the other half is folded to cover the window. In this way the bone lamina is stable. Cone Beam Computed Tomography was used to evaluate the efficacy of bone lamina to preserve the space in sinus lifting which contributes positively to wound healing and is effective in bone formation without biomaterials.

Pre-treatment with berberine enhances effect of 5-fluorouracil and cisplatin in HEP2 laryngeal cancer cell line.

Larynx squamous cell carcinoma represents one of the most common head and neck cancers in the world. Herbal drugs are popularly emerging as complementary and alternative therapies in cancer because of their cost effectiveness and minimal side effects. The present study was undertaken to explore the anti-tumor potential of berberine, an isoquinolone present in the extract of Tinospora cordifolia in HEP2 human laryngeal cancer cell line. Besides, it was aimed to investigate whether berberine could enhance the anti-cancer effect of 5-fluorouracil and cisplatin in HEP2. Our data seem to support a role for berberine in decreasing the expression of genes usually seen overexpressed in larynx squamous cell carcinoma and involved in pathways such as those of cell cycle and regulation, differentiation, and epithelial-mesenchymal transition. Moreover, a down regulation of these genes caused by cisplatin or 5-fluorouracil, treatment of election in laryngeal cancers was enhanced by a 4h pre-treatment with berberine.

Detection of endocarditis bacteria in tonsillar mucosa of Afghan population.

Endocarditis is a cardiovascular disease caused by the inflammation of the inner tissues of the heart, the endocardium, usually of the valves. Bacteraemia is essential in the development of endocarditis, and there are some findings that the main pathogens of endocarditis are viridans group streptococci: Streptococcus oralis, Streptococcus sanguinis, and Enterococcus faecalis. There is strong evidence that endocarditis bacteria are present in the tonsillar microbiota, so that tonsillar infection is associated with an increased risk of endocarditis. The aim of this manuscript is to investigate the presence of the main pathogens of endocarditis in tonsillar microbiota of an Afghan population group. A sample of 80 tonsil swabs were analyzed by quantitative real time PCR to detect endocarditis pathogens and an estimation of the total bacterial load. The median bacterial load in PCR reaction was 1.4x106 (interquartile range 4,7x105 - 2,9x106). Three species, S. Oralis, S. Sanguinis, and E. Faecalis were found in large amounts in all specimens. On the other hand, S. Mitis was never detected. The S. Aureus was found in 3 samples with a prevalence of 0.04 (C.I. 0.01-0.10). The S. Mutans was found in 33 samples with a prevalence of 0.41 (C.I. 0.31-0.52). Endocarditis bacteria has been found into the tonsillar microbiota, so there is sufficient evidence to justify that the oral cavity is a reservoir of endocarditis bacteria that can have a significant impact on the cardiovascular function.

Human polyomavirus in tonsillar microbiota of an Afghan population group.

Some studies have evidenced the role of human polyomaviruses in head and neck squamous cell carcinoma. BK, JC and SV40 human polyoma viruses are widely recognized as etiological agents associated with malignancies. The aim of this study was to analyse the prevalence of BK, IC and SV40 in tonsillar microbiota in a group of Afghan volunteers. A sample of the tonsillar microbiota was taken from a single site using a sterile oral swab paper stick. A fixed volume of purified DNA from each sample was tested by quantitative real-time polymerase chain reactions to evaluate the number of human cells and the number of viral genomes in each sample. The cell number was evaluated via the quantification of a single copy genomic sequence, which is located in the HMBS locus. The median analyzed cell number in each reaction was 4343 (interquartile range 2074-8470). SV40 was never detected, while prevalence rate was 0.11 (C.I. 0.06-0.20) for BK and 0.10 (C.I. 0.05-0.19) for JC. Further studies are necessary to clarify whether polyomaviruses can be considered a risk factor of oral, oropharyngeal and laryngeal malignancies.

The role of zinc plus octenidine in the regulation of gene expression: an in vitro study.

Zinc was known in ancient times, and is diffused in the environment. The potential benefits offered by zinc supplementary therapy have been demonstrated in numerous clinical trials using oral or topical zinc products. The benefit of zinc can be in principle increased through association with other actives. The aim of this study is to evaluate the effect on primary human gingival fibroblast cell of a new formulation containing zinc and octenidine cations. Human gingival fibroblast cells were obtained from three healthy patients (14-year-old man, 15-year-old woman and 20-year-old man) during extraction of teeth. The gene expression of 14 genes (ELANE, FN1, FBN, ITGA1, HAS1, ELN, DSP, ITGB1, HYAL1,TGFB1, TGFB2, TGFB3, TGFBR1 and TGFBR2) was investigated in HGF cell culture treated with 80µm of Octenidine, 1000µm of Zinc, 80µm Octenidine + Zinc solution and the medium alone at 30 min. Prestoblue™ data showed that as the active concentration increases (Octenidine, Zinc and Octenidine + Zinc) the percentage of cell vitality compared to that of untreated cells decrease. In this study, no statistically significant gene expression was observed between cells, treated with difference substances, and control cells. Our results points out that zinc plus octenidine shows a positive potential in periodontal disease treatment.

Zinc plus octenidine: a new formulation for treating periodontal pathogens. A single blind study.

Periodontal treatment has the aim to reduce oral infection, and prevent the progression of the disease. The potential benefits of new chemical devices for periodontal therapy, include improved patient compliance, an easier access to periodontal pocket and a lower dosage of antimicrobial agent. The objective of this study was to explore the efficacy of a chemical device containing zinc and octenidine in the treatment of chronic periodontitis in adult patients. Ten patients with a diagnosis of chronic periodontitis (20 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The chemical device zinc plus octenedine was used by each patient after daily oral hygiene. Microbial analysis were analyzed at baseline and on the 15th day. After the treatment, a remarkable decrease in bacteria amount, both for some species and for the total count was observed in the study group. Specifically T. Forsythia and T. Denticola were eradicated whereas Total Bacteria Loading and Fusobacterium Nucleatum showed a reduction of 38% and 55%, respectively. Our study demonstrated the efficacy of the new chemical device containing zinc and octenidine in a sustained release drug delivery system in the management of moderate to severe chronic periodontitis.

Human Papilloma Virus associated with oral cancer and preventive strategies: the role of vaccines.

The aim of this paper is to describe the efficacy of Human Papilloma Virus (HPV) vaccines for preventing oral cancer. A systematic review of the literature was conducted to describe the state of the art about HPV vaccines for preventing oral cancer. The aspects of prevention and control of infection by administering vaccines and the diffusion of sexual education campaigns are discussed also. In recent years there has been a growing interest in HPV in dentistry, suggesting a role of such a family of viruses in the development of oral cancers as well as of the uterine cervix. Even if the mass media have increasingly faced the problem, causing frequent alarming among patients, the dentist therefore needs a complete and up-to-date knowledge of this infectious condition that is one of the most common causes of sexually transmitted mucous membrane infections (eg genital, anal and oral). Recent studies about HPV infection are a basic requirement in order to promote the HPV vaccinations and patient’s health.

HPV acting on E-cadherin, p53 and p16: literature review.

In addition to tobacco and alcohol consumption, the two main risk factors for oral squamous cell carcinoma (OSCC), recent studies have revealed infections with human papilloma virus (HPV) as an additional risk factor for OSCC development. In the field of head and neck malignancies, the prevalence of HPV infections in oropharyngeal cancer (OC) ranges in different studies up to 84%. While HPV infection is discussed as an independent risk factor in this region, its distinguished role in carcinogenesis of tumours localized to the oral cavity remains uncertain. A systematic literature search was performed using PubMed, Cochrane library, Science Direct, and the Internet search, with language restricted to English. The search included published studies which dealt with detection methods of HPV-related oral and oropharyngeal cancers and biomolecular studies, particularly regarding the compromising of p53 p16 and e-cadherin’s. P53 Tumour suppressor protein p53 has several functions that are related to maintaining genomic stability and inhibiting cell proliferation in response to DNA damage. For preventing neoplasia to occur, the most important of these functions are cessation of cell growth and induction of either apoptosis or senescence. P16 is a cellular protein involved in cell cycle regulation. It is a cyclin-dependent kinase 4 (CDK4) inhibitor, and is integral to Rb mediated regulation of G1-S phase of the cell cycle. P16 is expressed at a very low level in normal cell as Rb inhibits transcription of p16. Various detection methods ranging from immunohistochemistry (IHC) to molecular techniques have been used to determine the HPV status of HNSCC. E-cadherin, a 120 kDa Type I classical cadherin, is expressed primarily on epithelial cells. It is found on the surface of keratinocytesand Langerhans cells (LC) and E-cadherin mediated adhesion between these cell types is required for LC retention in the epidermis. It is also an important tumour suppressor protein: its loss or inactivation is associated with epithelial-to-mesenchymal transition (EMT), a process involving dedifferentiation, infiltration and metastasis of tumours. Oral carcinogenesis is a multi-factorial process involving socioeconomic, environmental and microbial factors leading to multistep changes. Smoking and tobacco exposure seems to modify the survival and recurrence of HPV positive tumours and should be considered in future trials for risk stratification of HPV positive patients. HPV associated oropharynx cancer represents a distinct clinical and biologic entity with many unresolved issues that will be investigated in future translational, clinical research. We need to further explore and understand why the disease occurs predominantly in males, and whether the natural history of oral HPV infection differences in men and women.

Colonization of Legionella spp. In dental unit waterlines.

Legionella spp. are ubiquitous in aquatic habitats and water distribution systems, including dental unit waterlines. Surveys have shown that the percentage of samples taken at different dental sites that were positive for Legionella spp. were highly variable and ranged from 0% to 100%. Cultivation is the principal approach to evaluating bacterial contamination employed in the past, but applying this approach to testing for Legionella spp. may result in false-negative data or underestimated bacterial counts. PCR and direct fluorescent counts can detect viable non-cultivable bacteria, which are not counted by plating procedures. Legionella spp., commonly form such viable non-culturable cells and it is likely that they contribute to the difference between plate count results and those of PCR and fluorescent-antibody detection. However, studies have shown that Legionella is present in the municipal water source in spite of the current filtration and chlorination procedures. Once Legionella reaches the building water system, it settles down into a biofilm layer of stagnant water. By means of this layer, Legionella can protect itself from antimicrobial agents and then multiply. Dental unit waterlines may be contaminated with opportunistic bacteria. The water quality in the dental units should be controlled to eliminate opportunistic pathogens and to provide water for dental treatment that meets public health standards for potable water.

Focus on periodontal disease and development of endocarditis.

Infective endocarditis is a devastating disease with high morbidity and mortality. The link to oral bacteria has been known for many decades and has caused ongoing concern for dentists, patients and cardiologists. The microbiota of the mouth is extremely diverse and more than 700 bacterial species have been detected. Half of them are uncultivable so far. Oral microbiota is not uniform, specific sites exist in the mouth such as tongue, palate, cheek, teeth and periodontal pockets that have their own microbiota. Factors involved in the development of a bacterial endocarditis are difficult to define but a vulnerable surface (i.e. a damaged endocardium) and a high bacterial load in the blood seems to be decisive. The cause of microorganisms, in 90% of cases, are staphylococcus, streptococcus and enterococcus. Oral streptococci belong to viridans group (streptococcus mutans and streptococcus sanguis). As they are part of dental plaque, they could enter the bloodstream causing bacteraemia through daily habits like chewing or tooth brushing. Effective treatment of periodontal infections is important to reduce local inflammation and bacteraemia. In addition, poor periodontal health appears to increase the risk of cardiovascular disease, pulmonary disease, and preterm and low birth weight. CONCLUSIONS: Long-standing oral disease prevention protocols reduce the risk of developing periodontal disease. Data suggests that methods used to prevent cases of IE that originate from oral bacteria should focus on improving oral hygiene and reducing or eliminating gingivitis, which should reduce the incidence of bacteraemia after tooth-brushing and the need to extract teeth owing to periodontal disease and caries.

Human papilloma virus in the tonsillar microbiota of an Afghan population group.

Cancer of the oral cavity is known to have a diverse aetiology that includes infectious agents. Human papilloma virus has been found to be associated with several types of human cancer, inclusive of cervical, vulvar, vaginal, penile, anal, and cancer of tonsil. The aim of this manuscript is to investigate the presence of human papilloma virus in tonsillar microbiota of an Afghan population group. A sample of the tonsillar microbiota was collected by oral swab paper stick from 80 healthy donors. The sample was investigated for the presence of high-risk human papillomavirus types 16, 18, 31 and 45 by real time PCR. Eight samples produced some positive endpoint signals for human papillomaviruses. The human papillomavirus 31 was the unique papillomavirus detected; its calculated prevalence rate was 0.10 (C.I. 0.05-0.19). However, the viral load was always very low, in the order of 10-3 viral genomes per cell. The high prevalence of high-risk human papillomavirus in healthy population suggest a need for further investigation on virus spreading and supports the development of vaccination strategies.

Malar region rejuvenation through non-invasive techniques: hyaluronic acid fillers and lipofilling.

Contour enhancements of the midface make up a dominant aspect of aesthetic surgery. The goal of midface rejuvenation is to decrease the prominence of grooves and creases as well as to provide volume to atrophied tissue. There are various options, including autologous tissue grafts, allogenic tissue grafts and alloplastic materials. In turn, patients’ needs have led to an increasing trend of less invasive treatments. In the present study, 82 implants were used for midface augmentation in 41 patients (38 women, 3 men) between January 2014 and January 2016. Twenty-five patients were treated with Hyaluronic acid implants while the remaining 16 patients were treated with lipofilling. For both groups and in all cases, good integration of the filled material was observed in the malar region, with no significant treatment complications and the last follow-up visit demonstrated good results and overall satisfaction. Hyaluronic acid fillers and lipofilling are therefore the ideal answer to patients who aim for a natural and immediate result with manageable complications, but, unlike Hyaluronic acid, autologous fat allows us to obtain a long-lasting effect over time, resulting the closest thing to an ideal facial filler.