Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Κυριακή 29 Μαΐου 2022

Long-term results of slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

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Publication date: July 2022

Source: International Journal of Pediatric Otorhinolaryngology, Volume 158

Author(s): Eszter Erdélyi, Ádám Bach, Balázs Sztanó, Péter Gál, Kishore Sandu, Csaba Bereczki, László Rovó

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Prenatal exposure to phthalate and decreased body mass index of children: a systematic review and meta-analysis

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Carglumic acid in methylmalonic acidemia: Use of breast milk as an alternative vehicle to water

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Carglumic acid in methylmalonic acidemia: Use of breast milk as an alternative vehicle to water

We aim to report the use of breast milk (BM) as an alternative vehicle in a neonate with methylmalonic acidemia rejecting carglumic acid (NCG) diluted in water. The patient presented symptomatic acidemia and hyperammonemia and after refusal of oral NCG administration, the clinician consulted the Pharmacy Department for advice. Data sheet of NCG does not recommend administration in other vehicle than water. Consequently, a dissolution test was conducted in BM showing correct dissolution. The solution was well tolerated, and plasma ammonium concentrations remained within range in subsequent analytical controls.


Abstract

What Is Known and Objective

Carbaglu® or N-carbamylglutamate (NCG) is not recommended for administration in a vehicle other than water. We aim to report the use of breast milk (BM) as an alternative vehicle in a neonate rejecting NCG diluted in water.

Case Summary

A neonate diagnosed with methylmalonic acidemia presented symptomatology of acidemia and hyperammonemia. After the patient refused oral NCG administration, a dissolution test was conducted in BM showing correct dissolution. The NCG-BM solution was tolerated and plasma ammonium concentrations remained within range in subsequent analytical controls.

What Is New and Conclusion

BM as a vehicle for NCG is a safe and effective option for patients who refuse suspension in water and could lead to better treatment compliance in paediatric patients.

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Molecular basis for avirulence of spontaneous variants of Porphyromonas gingivalis: genomic analysis of strains W50, BE1 and BR1

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Abstract

The periodontal pathogen Porphyromonas gingivalis is genetically heterogeneous. However, the spontaneous generation of phenotypically different sub-strains has also been reported. McKee (McKee et al., 1988) cultured P. gingivalis W50 in a chemostat during investigations into the growth and properties of this bacterium. Cell viability, on blood agar plates, revealed two types of non-pigmenting variants, W50 Beige (BE1) and W50 Brown (BR1) in samples grown in a high haemin medium after day 7 and the population of these variants increased to approximately 25% of the total counts by day 21. W50, BE1 and BR1 had phenotypic alterations in pigmentation, reduced protease activity and haemagglutination, and susceptibility to complement killing. Furthermore, the variants exhibited significant attenuation in a mouse model of virulence. Other investigators showed that in BE1, the predominant extracellular Arg-gingipain was RgpB, and no reaction with an A-LPS specific MAb 1B 5 (Collinson et al., 1998; Slaney et al., 2006). In order to determine the genetic basis for these phenotypic properties we performed hybrid DNA sequence long reads using Oxford Nanopore, and the short paired-end DNA sequence reads of Illumina Hiseq platforms to generate closed circular genomes of the parent and variants. Comparative analysis indicated loss of intact kgp in the 20 kb region of the hagA-kgp locus in the two variants BE1 and BR1. Deletions in hagA led to smaller open reading frames in the variants, and BR1 had incurred a major chromosomal DNA inversion. Additional minor changes to the genomes of both variants were also observed. Given the importance of Kgp and HagA to protease activity and haemagglutination respectively in this bacterium, genomic changes at this locus may account for most of the phenotypic alterations of the variants. The homologous and repetitive nature of hagA and kgp, and the features at the inverted jun ctions are indicative of specific and stable homologous recombination events which may underlie the genetic heterogeneity of this species.

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The concordance between wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS-3D) and standard endoscope biopsy in the detection of Barrett's esophagus and esophageal dysplasia

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Publication date: Available online 28 May 2022

Source: Annals of Diagnostic Pathology

Author(s): Chaohui Lisa Zhao, Zarrin Hossein-Zadeh, Bahram Dabiri, Solomon Turunbedu, Gerasimos Karalis, Behnam Rafiee, Alex Pipas Rodriguez, Iman Hanna

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Subjective Sleep Complaints were Associated with Painful Temporomandibular Disorders in Adolescents: the Epidor‐Adolescere Study

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Abstract

Background

Sleep disturbances in adolescents has received a lot of attention in the literature and it is recognized as a serious health concern. The association between pain and sleep disturbances in adolescents has been extensively studied. However, to the best of our knowledge, there is a lack of studies investigating the association between various subjective sleep variables and painful TMD in adolescents.

Objectives

to investigate the association between painful TMD and subjective sleep variables in adolescents' non-clinical sample. We conducted a cross-sectional study. TMD was classified according to the RDC/TMD criteria. The Revised Face Scale evaluated TMD pain intensity, and pressure pain thresholds (PPTs) were assessed in trigeminal and extra-trigeminal areas. The subjective sleep variables were assessed according to the Sleep Disturbance Scale for Children and Sleep Behavior Questionnaire.

Results

The final sample consisted of 690 adolescents (12.7±0.76 years), with 16.2% of them presenting painful TMD. Adolescents who frequently reported waking up more than twice per night and feeling tired when awake were more likely to present painful TMD symptoms [OR= 1.7 (95% CI: 1.04-2.90); p=0.034 and OR= 1.6 (95% CI: 1.01-2.48); p=0.046, respectively]. The intensity of TMD pain was negatively associated with sleep quality (p=0.015). Also, PPT values in the trigeminal and extra-trigeminal areas were negatively associated with total sleep time (p= 0.048 and p=0.042, respectively).

Conclusions

the present results point out the importance of considering sleep complaints associated with painful TMD in adolescents.

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Is It Possible to Stop a Dental Abscess?

alexandrossfakianakis shared this article with you from Inoreader


In the spirit of full transparency, we didn't start OraWellness because we always had or were blessed with awesome oral health. We started OraWellness after we successfully created greater oral health and learned how to recover from rather unfortunate (and all-too-common) starting points.

If you've been with us for any time, you probably already know our 'origin story' and how Susan used at-home strategies to care for her oral health and successfully reverse advanced gum disease. (As an important side note, Susan accomplished this 'dental miracle' without any oral surgery or help from a dental hygienist.) 

And she continues to leave dentists scratching their heads in confusion, making comments like, "I can clearly see that you had gum disease. But I don't see any current signs of active infections.

The original dentist considered this a dental miracle, but after more than 12 years of sharing Susan's strategies with the world, we've realized that it's no miracle at all. However, it is amazing how quickly the body responds and heals itself when you accept the role of the MVP and take appropriate action.

Today's story will continue to explore this same theme of Susan's journey to greater oral health. We're going to share how Susan successfully healed an abscess after two dentists said it could only be addressed by removing the tooth.

Disclaimer: We are not qualified medical or dental professionals, so we can't treat, diagnose, make recommendations, etc. We're sharing this story for informational purposes only. Please don't mistake any of this content for suggestions of what you should do to treat an abscess. Abscesses are serious business that shouldn't be taken lightly. If you suspect you have one, here's a helpful resource you can use to find a qualified dentist to assist you.


What is a dental abscess?

An abscess is simply an infection, and it can occur anywhere in the body. In our oral health world, a 'dental abscess' refers to an infection under the gums, normally at the root of a tooth. A dental abscess commonly originates from three sources: a deep infection in the tooth or gum pocket, an injury, or old (failed) dental work. In particular, dental abscesses tend to show up around teeth that have been killed via a root canal.

In Susan's case, the abscess was at the root of a malformed tooth. It's always been a tooth that dentists have looked at and wondered what they were seeing. A well-known dentist told her it was two teeth growing as one. Other dentists had also told her that the tooth was 'dying'. Using a cone beam x-ray, a dentist found a periapical (meaning 'around the root') abscess. This type of abscess is pretty common.


How do you know if you have a dental abscess?

Abscesses are bacterial infections. As the infection progresses, it builds up pus that needs to go somewhere. If you've ever had a 'pimple' on your gum tissue (especially if it's recurring), this is a pretty sure sign of an infection in the tissue around the root of the tooth in that area. 

As pus continues to fill the abscessed area, it creates pressure, which can cause pain. Eventually, the increased pressure causes the abscess to vent, meaning it seeks a pathway for the pus to get out of the region. The problem is that sometimes, a dental abscess can vent into less-than-ideal places. For example, an infection in the upper jaw may vent into the sinus cavity. Luckily, Susan's dental abscess vented to the side of the gum next to her cheek. 

The problems and health risks associated with abscesses are real and may need to be diagnosed and addressed by a professional, but for the sake of this article, we want to explore how one person successfully stopped her own dental abscess.

If you question whether you have a dental abscess, this is a situation that needs attention. Please seek the support of a dental team that you trust, ideally one that will use 3D cone beam x-ray technology to make a diagnosis and help you determine a course of action.


The initial point of entry…

During our HealThy Mouth World Summit, we had the honor of interviewing Dr Hal Huggins (before he passed away a couple of years later). Thanks to that interview, we had the opportunity to send our x-rays to one of the experts who trained extensively with Dr Huggins.

This dentist explained that Susan's malformed tooth is a dental anomaly called 'dens in dente' (meaning 'tooth within a tooth') where the wisdom tooth and the molar in front of it came in 'together'. As it turns out, while this anomaly isn't common, it isn't super rare either.


Getting a cone beam 3D x-ray to confirm the problem

It's our understanding that the 3D x-ray technology called 'cone beam' is superior to traditional dental x-rays because it provides dental teams with a wider array of information and a much better understanding of what's going on under the surface.

So when we moved from Hawaii back to the mainland in 2018, Susan took advantage of the opportunity and got a cone beam scan. (While Hawaii is great for many things, holistic dentistry is not one of them.)

This was the first time a dentist diagnosed the abscess around this troublesome molar. His suggested course of treatment was to pull the tooth, let the area heal, and then place an implant.

And, just like when a previous dentist told Susan she had advanced gum disease, Susan said, "Hmm, ok, thanks for the information. I'm going to do some research on other options. I'll let you know if I want to schedule this." Then she promptly left the dental office and got to work. (Never forget that you're the boss, the MVP, of your oral health journey.)

As a side note, thermal imaging can also be a very helpful way to determine if an infection is brewing around a tooth. For someone who is looking to take action to make positive changes to their oral and/or whole-body health, thermography can help provide a sense of where infections might be lingering.


Confirmation of healing…

Before we jump into the strategies that might help address an abscess, we'd like to share the end of this story. Susan went to a new dentist close to home, who reviewed her cone beam x-ray from the previous dentist and proclaimed, "You have an abscess there. We've got to pull that tooth.

Susan explained that she had been supporting the region and wanted to get a more recent scan to see if any change had occurred. The dentist reluctantly agreed, and lo and behold, he found no more infection around that tooth! 🙂 

The dentist was excited, puzzled, and genuinely curious by this, and he enthusiastically asked Susan what she had done to address the infection (which, by the way, is a precious sign that the dentist is still open to learning and discovering new solutions). This led to a lively conversation about systemic immune support strategies, and the dentist confirmed that he understood how Susan's strategies had worked. 

Now that we've shared that backstory, let's shift to solutions and strategies that can help support the body's innate ability to get on top of an infection like a dental abscess.

Full disclosure: We're going to share a variety of helpful strategies and point out which general tracks Susan chose to take, but since the information in this article is not intended to be any kind of suggestion for what anyone else should do, we're not going to share any specific details about what she did. Trust your gut. Do what feels right to you. Read through the list of helpful strategies and see if any of them resonate with you. Applying even just one of the strategies can help increase the body's natural ability to get on top of an infection.


The challenge with accessing a dental abscess…

Here's the thing: an abscess that's located at or around a tooth root is not accessible from inside the mouth.

Yes, it might help somewhat if we put herbal poultices between the cheek and gum tissue right at the point of infection. But the bottom line is that unlike gum disease, with a dental abscess, you don't have access to address the source of the infection itself.

So, the primary route to address this issue is via whole-body, system-wide immune supporting strategies.

And, that means… Yep, we have to address things that we may not be thrilled to adjust at this point, like optimizing our diet.

Before we dive into dietary changes, let's start with some less intimidating strategies that can be applied at home or with the help of a caring dental team.


Simple at-home, in-the-mouth approaches:

Vigorous swishing with salt water – Salt naturally 'draws out' infections. So, while you don't have direct access to the infection, using salt may help to draw it to the surface. 

A commonly overlooked part of this strategy is the vigor with which to swish. It's important to really activate the area by vigorously swishing the salt water around the mouth. Feel free to download our free eBook, The Ultimate Oil Pulling Guidebook, which explains more about this type of 'vigorous swishing' strategy.

Make an herbal poultice – When it comes to solutions from nature, the sky's the limit. One idea is to try crushing up some garlic and tucking the crushed clove between the cheek and gum around the affected region. Crushing fresh oregano is another option. And there's always our favorite, crushed dandelion, to help clear heat and toxins.

Direct massage using HealThy Mouth Blend – Another pretty simple strategy is to gently massage 1-2 drops of our HealThy Mouth Blend into the affected area. The balanced formula will help soothe and support the region. We've received confirmation from several people in our community that this strategy really helped them manage a dental abscess.

A mixed approach – What about making up a poultice using some fresh crushed garlic, dandelion, and oregano with a pinch of salt, and then putting that 'bolus' between the cheek and gum near the affected region? While we don't generally believe that 'more is better', in this case, there may be some benefit to mixing various supportive herbs.


Dentist-supported in-the-mouth strategy:

Application of ozone gas into the infection – Here's a novel idea that some dentists have been willing to contemplate. If you have a dentist who works with ozone gas (a minority for sure), feel free to ask them if they would be willing to inject a syringe of ozone gas into the periapical region. Slow release of ozone into the site of the infection could go a LONG way toward helping to reduce the localized infection. This simple strategy solves the issue of not being able to access the dental abscess by placing an amazingly powerful anti-infective, ozone, directly where it's needed.

They might need to do more than one injection, but given that we're trying to avoid having a tooth extracted, it's worth the effort.

Alternatively, a strategy that Susan used was to massage a drop of ozonated oil onto the affected site. Although this might not directly reach the epicenter of the infection, the advantage of this supportive strategy is that it doesn't require assistance from a dental team. Here's a link to some quality ozonated oils.


System-wide immune support strategies:

Homeopathics – Let's start with the easiest support. It's our understanding (and was Susan's experience) that the homeopathic remedy Hepar Sulphuris Calcareum (aka 'Hepar Sulph') is fantastic for helping to drain infections like an abscess. Here's a great resource to learn more about using homeopathy for dental abscesses.

High-dose vitamin C – It's been known for many decades now: vitamin C is a powerful anti-infective agent that can even help to address super serious issues like sepsis (1). So, while you want to be cautious if you're going to use high doses, stepping up your vitamin C intake can help to support oral healing (2) and 'cook out' any lingering infections.

Keep in mind, if you take too much, your body will let you know with pretty profound diarrhea. The strategy here is to find your 'near bowel tolerance' amount, which is just under the amount that causes diarrhea. Holding at near bowel tolerance for a few weeks can certainly help address chronic infections.

Optimize vitamin D intake – Another easy strategy is to make sure that you're getting plenty of vitamin D. And if you're going to increase your D, please be sure to increase your vitamin K2 as well. At the advice of a doctor, Susan supplemented with therapeutic doses of vitamin D for a period of time. 

While there's plenty of both good and bad PR about vitamin D, there are many accounts of people taking pretty high amounts of vitamin D for shorter periods of time to help ramp up immune function so they can knock out an infection.


Supportive strategies at a professional clinic:

Intravenous vitamin C (and other goodies) – High doses of oral vitamin C can trigger the 'bowel tolerance' that we discussed. However, we can receive much higher amounts of vitamin C intravenously without the rush to the bathroom.

Plus, if you work with a naturopathic doctor, they might have other beneficial compounds that they could work into an immune-supporting 'cocktail' to deliver intravenously along with the vitamin C.

Note: folks who have a genetic disorder known as 'G6PD deficiency' could experience serious complications from high dose intravenous vitamin C. So if you're not sure if you have this genetic predisposition, be sure that your doctor tests for it before you try intravenous vitamin C.

Hyperbaric oxygen therapy – Hyperbaric oxygen therapy (HBOT) continues to show tremendous immune system benefits. It helps deliver oxygen into tissues, and it's especially helpful for low-oxygen areas that need the extra boost.

While 'on-label' HBOT treatment is limited to conditions like gangrene, severe burns, slow healing wounds like diabetic ulcers, and crush injuries, the data is super clear that breathing oxygen while under hyperbaric pressure provides profound benefits, especially for addressing lingering chronic infections (3).

This makes sense because many of the bacteria that are associated with chronic infections tend to thrive in an anaerobic (oxygen-deprived) environment, so when we supersaturate the surrounding tissues with oxygen, it's more difficult for these anaerobic bacteria to survive.

You can find more information on the use of hyperbaric oxygen here. One word of caution: to ensure that you get the maximum benefit from HBOT, there are two crucial factors to consider: 

  1. While in the tank, you must be delivered pure (100%) or close-to-pure oxygen via a mask.
  2. Pressures must be equal to or greater than 1.6 atmosphere absolute (ATA).

There are lots of HBOT spas around the world now. Unfortunately, many of them take advantage of an unknowing public to get new people into their clinics. Most of the HBOT centers we've seen do not have the capacity to deliver pure oxygen at the pressures that are necessary in order to provide this therapy's benefits.

If you're looking to leverage HBOT to support the healing of a dental abscess, it would be ideal if you could get a handful of sessions where they take you down to 2.0 ATA while breathing pure oxygen.


Other systemic support strategies:

Now let's broaden this out to strategies that we all know are good for us. Improving our diet, getting optimal exercise and outdoor time, spending quality time with loved ones, and making time for contemplation/prayer/meditation are all awesome for our immune health. But, many of us find it difficult to start implementing these kinds of lifestyle changes.

The strategy here is to just pick one today.

What's the easiest, lowest hanging fruit for you?

Can you stop the sodas? Reduce your coffee consumption? Provide yourself with a little more rest or self-care time on the weekend?

Really, anything we do to help us feel a little more cared for can go a long way toward supporting a general feeling of ease and well-being. And that, friends, is what moves the needle of our immune function.

Here are a few resources to help you along this path:


Wrapping up…

In conclusion, is it possible to stop a dental abscess without a tooth extraction? Based on Susan's experience, we believe it is. In fact, we know it is. 

Remember, the most important step of this entire process is to put on your superhero cape and become the MVP of your health journey (and finding a good dental team who will work with you to help monitor your progress can be a big help, too).

We're here with you every step of the way. If you have any questions, please holler. We can't give medical or dental advice, but we can listen, help you brainstorm ideas, and share resources to help you navigate your path to optimal oral (and whole-being) health.

What about you–what immune-supportive strategies have helped in your life? What hurdles have you overcome by taking the lead on your health journey? Please share your stories in the comments below. Together we can learn so much from one another!


Helpful, related resources:


Other resources:

The post Is It Possible to Stop a Dental Abscess? appeared first on OraWellness.

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Plasma trough concentration distribution and safety of high‐dose teicoplanin for patients with augmented renal clearance

alexandrossfakianakis shared this article with you from Inoreader
Plasma trough concentration distribution and safety of high-dose teicoplanin for patients with augmented renal clearance

Teicoplanin plasma trough concentration (C min) and probability rates of C min > 10 mg/L in the augmented renal clearance (ARC) and non-ARC groups on the third day of medication (day 3) and during the dose maintenance period. After the HD, plasma samples were collected before the third day of medication. The teicoplanin C min values in the ARC and non-ARC groups were 17.3 ± 9.2 mg/L and 15.5 ± 7.9 mg/L, respectively (p = 0.663) (Figure A). The probability rate of C min > 10 mg/L also did not differ significantly between the two groups (85.7% [6/7] vs. 60.0% [6/10], p = 0.338, Figure C). During the dose maintenance period (3 days after medication), the teicoplanin C min was significantly lower in ARC group than in the non-ARC group (18.3 ± 5.1 mg/L vs. 25.5 ± 11.9 mg/L, p = 0.016, Figure A), while there was no significant difference in the probability rate of C min > 10 mg/L between the two groups (90.0% [9/10] vs. 96.2% [25/26], p = 0.484, Figure C). After the LD, plasma samples were collected before the third day of medication. The teicoplanin C min values in the ARC and non-ARC groups were 6.8 ± 3.9 mg/L and 7.9 ± 3.1 mg/L, respectively (p = 0.585) (Figure B). The probability rate of C min > 10 mg/L did not differ significantly between the two groups (20.0% [1/5] vs. 11.1% [1/9], p = 1.000, Figure D). During the dose maintenance period, the teicoplanin C min values in the ARC and non-ARC groups were 12.2 ± 6.3 mg/L and 13.0 ± 4.6 mg/L, respectively (p = 0.713) (Figure B). The probability rate of C min > 10 mg/L was 61.5% (8/13) in both groups (Figure D). It should be noted that on the third day of medication, the HD group had a significantly higher teicoplanin C min than the LD group for ARC (17.3 ± 9.2 mg/L vs. 6.8 ± 3.9 mg/L, p = 0.039, Figure A and B), but there was no significant intergroup difference in the probability rates of C min > 10 mg/L (85.7% [6/7] vs. 20.0% [1/5], p = 0.072, Figures C and D). During the dose maintenance period, the teicoplanin C min was significantly higher in the HD group than in the LD group for ARC (18.3 ± 5.1 mg/L vs. 12.2 ± 6.3 mg/L, p = 0.022, Figures A and B), while there was no significant intergroup difference in their probability rates of C min > 10 mg/L (90.0% [9/10] vs. 61.5% [8/13], p = 0.179, Figures C and D). Notes: A, HD; B, LD; C, HD; D, LD; *p < 0.05.


Abstract

What Is Known and Objective

There are few reports on the distribution of the plasma trough concentration (C min) of teicoplanin in patients with augmented renal clearance (ARC) and on the safety of a high-dose regimen (HD; 800 mg loading dose for q12h three times followed by an 800 mg qd maintenance dose). The objective of this study was to determine the C min values of teicoplanin in ARC patients using HD teicoplanin to provide a reference for individualized medication.

Methods

Data on patients treated with teicoplanin from January 2019 to January 2021 were collected retrospectively and divided into ARC (creatinine clearance rate [CCr] >130 ml/min, n = 22) and non-ARC (60 ml/min ≤ CCr ≤130 ml/min, n = 24) groups. The C min values in the two patient groups were analysed during the HD and the low-dose regimen (LD; all other regimens) on the third day of medication and during the dose maintenance period. Liver and kidney function indexes were also analysed before and after medication.

Results and Discussions

On the third day of the HD, C min did not differ significantly between the ARC and non-ARC groups (17.3 ± 9.2 mg/L [mean ± SD] vs. 15.5 ± 7.9 mg/L, p = 0.663), while C min in the ARC group was significantly lower for the LD (6.8 ± 3.9 mg/L, p = 0.039). During the dose maintenance period, C min in the ARC group when receiving the HD (18.3 ± 5.1 mg/L) was significantly lower than that in the non-ARC group (25.5 ± 11.9 mg/L, p = 0.016) and significantly higher than that for the LD (12.2 ± 6.3 mg/L, p = 0.022). Nephrotoxicity and hepatotoxicity incidence rates did not differ significantly between these groups.

What Is New and Conclusion

These results suggest that it is necessary to apply a loading dose of 800 mg (but not higher) q12h three times for patients with ARC, with 800 mg needed as a maintenance dose during severe infection, and 600 mg or 400 mg for mild infection.

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