RESUMEN
PURPOSE: To assess primary and secondary stability of variable-thread tapered implants in the posterior maxilla and analyze the impact of various factors on implant stability quotients (ISQs). MATERIALS AND METHODS: Twenty-six subjects received 3-4 adjacent implants in the maxillary premolar-molar sextants to replace bilateral tooth loss. The implants on one side were immediately loaded with a provisional fixed prosthesis regardless of their primary stability. The contralateral control implants were conventionally loaded. Bone quality was subjectively recorded and primary stability was assessed by means of insertion torque values (ITVs) and ISQs in 4 directions. Secondary stability was measured by ISQ at definitive prosthesis delivery (3-3.5 months postoperatively), and 12 months after definitive loading. The impact of measurement direction, loading protocol, time, site-related (bone quality, implant position, crestal buccal bone thickness, apical cortical anchorage), and implant-related (implant dimensions, abutment height) variables on ISQs was assessed. RESULTS: For logistic reasons, ISQs were obtained for only 18 patients with 60 test and 60 control implants. Most of the implants (82%) at baseline had their lowest ISQ on the buccal aspect. There were no significant differences between ISQs measured in the buccal and palatal directions, or between ISQs in the mesial and distal directions. The mean of buccal and palatal ISQs was significantly lower than the mean of the 2 interproximal measurements at all evaluation periods. ISQs were not significantly different between the 2 loading groups at any time point. All implants showed a time-dependent increase in ISQs. Baseline ISQ correlated weakly with bone quality and ITV. None of the variables had a significant impact on baseline ISQs, except for implants in second molar sites which showed poorer primary stability than first premolars. CONCLUSION: Measurement direction and time are the most significant parameters affecting ISQs of variable-thread tapered implants in the posterior maxilla.
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Implantes Dentales , Carga Inmediata del Implante Dental , Diente Premolar/cirugía , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Humanos , Maxilar/cirugíaRESUMEN
PURPOSE: To compare the 3-year outcomes of immediately loaded and one-stage conventionally loaded variable-thread tapered implants in the posterior maxilla. MATERIALS AND METHODS: This study was designed as a split-mouth randomised controlled trial. Twenty-six patients attending the postgraduate Periodontics Department at the Lebanese University, and missing teeth bilaterally in the posterior maxilla were randomised. All patients received three to four implants in each of the posterior sextants. The implants on one side were immediately loaded with a provisional resin fixed partial denture on definitive multi-unit abutments regardless of their primary stability. The implants in the contralateral side received definitive multi-unit abutments according to the one-stage unloaded protocol. Three to 3.5 months following implant placement, the implants were restored with metal-ceramic fixed prostheses. Outcome measures were implant and prosthesis failure rates, complications, and peri-implant bone level changes up to 3 years following delivery of the definitive prosthesis. The clinical outcomes and radiographic measurements were performed by a single outcome assessor blinded to the type of interventions. RESULTS: Two patients dropped out prior to the delivery of definitive prostheses. The results were analysed using a per-protocol analysis and included 24 patients. Four implants supporting a four-unit immediately loaded prosthesis failed in one patient, 3 months following definitive prosthesis. In the same patient, the three contralateral conventionally loaded implants failed 14 months after definitive prosthesis. There were no significant differences in the proportions of implant and prosthesis failures at 3 years (difference = 0%; 95% CI 0.0% to 14.2%; P = 0.999). Peri-implantitis was diagnosed at two adjacent conventionally loaded implants in one patient at the 3-year examination. In the immediately loaded group, four early minor prosthetic complications occurred during the provisionalisation phase. Following delivery of the definitive prostheses, one minor ceramic fracture was observed in each of the implant groups. The difference in the rate of complications between the two interventions was not statistically significant at 3 years (difference = 13%; 95% CI 3.4% to 27.7%; P = 0.453). The 3-year peri-implant marginal bone level changes were evaluated in 23 patients (77 immediately loaded and 76 conventionally loaded implants). On average, patients lost 0.79 (0.62) mm at the immediately loaded and 0.91 (0.82) mm at the conventionally loaded implants, the difference being statistically not significant (difference = 0.12 mm; 95% CI -0.31 to 0.55 mm; P = 0.590). The 3-year marginal bone level changes were not significantly different between smokers (n = 12) and non-smokers (n = 11) (difference = 0.19 mm; 95% CI -0.24 to 0.62 mm; P = 0.382). CONCLUSIONS: Immediate loading of three- to four-unit fixed partial prostheses supported by variable-thread implants in the posterior maxilla can achieve similar 3-year results to one-stage conventionally loaded implants.
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Pérdida de Hueso Alveolar , Carga Inmediata del Implante Dental , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Dentadura Parcial Fija , Humanos , MaxilarRESUMEN
RATIONALE: Pain assessment and treatment is influenced by subjective perception of pain. Despite the international efforts to implement guidelines and protocols for pain management, pain continues to be regarded as a complication rather than a primary problem. The literature pertaining to the adequacy of pain management in the Middle East is frail. This study focuses on revealing the implemented practices of initial pain assessment, follow-up and re-evaluation of pain treatment in Lebanese hospitals. AIM AND OBJECTIVES: The objective of this study is to evaluate the presence and effectiveness of acute pain management and its impact on the quality of life in hospitals throughout Lebanon, in both cancer and non-cancer populations. METHODS: A Lebanese multi-centre, prospective, chart review study was conducted over a period of 3 months. Data on demographics, pain medication, dose, route, duration and adjunct pain management were collected. Appropriateness of pain management was determined as per World Health Organization guidelines. Institutional Review Board approvals were obtained from each hospital. RESULTS: Results from 582 participants revealed that 50% of initial pain assessment intensity scores were based on the assumptions of health care professionals. Furthermore, as pain severity scores increased, the adequacy of pain management decreased. Only 22% of the patients had a daily follow-up, and the majority of those continued to receive inappropriate therapy. CONCLUSION: This study reflects the lack of a well-structured system for pain management in Lebanese hospitals. It underlines the need for pain research in the region. It also highlights the need for implementing the recommendations discussed to minimize risk and optimize pain management.
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Dolor Agudo , Manejo del Dolor , Dimensión del Dolor , Guías de Práctica Clínica como Asunto/normas , Dolor Agudo/diagnóstico , Dolor Agudo/psicología , Dolor Agudo/terapia , Adulto , Anciano , Países en Desarrollo , Femenino , Necesidades y Demandas de Servicios de Salud , Hospitales/estadística & datos numéricos , Humanos , Líbano , Masculino , Persona de Mediana Edad , Manejo del Dolor/métodos , Manejo del Dolor/normas , Dimensión del Dolor/métodos , Dimensión del Dolor/normas , Percepción del Dolor , Calidad de Vida , Resultado del Tratamiento , Organización Mundial de la SaludRESUMEN
Candida albicans is an important fungal pathogen of humans that is responsible for the majority of mucosal and systemic candidiasis. The host-pathogen interaction in C. albicans has been the subject of intense investigation as it is the primary step that leads to establishment of infection. Hwp2 is a cell wall GPI-anchored cell wall protein that was previously shown to be necessary for hyphal and invasive growth on solid media. The purpose of the current study is to further characterize the protein as far as its role in oxidative stress, sensitivity to cell wall disrupting agents, adhesion to human epithelial and endothelial cells, biofilm formation and chitin content. It appears that Hwp2 is necessary for proper oxidative stress tolerance, adhesion and biofilm formation as an hwp2 null is more susceptible to increasing doses of hydrogen peroxide, unable to adhere efficiently to epithelial and endothelial cell lines and unable to form wild type biofilm levels.
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Biopelículas/crecimiento & desarrollo , Candida albicans/fisiología , Adhesión Celular , Proteínas Fúngicas/metabolismo , Estrés Oxidativo , Candida albicans/genética , Candida albicans/metabolismo , Candida albicans/patogenicidad , Línea Celular , Células Endoteliales/microbiología , Células Epiteliales/microbiología , Proteínas Fúngicas/genética , Técnicas de Inactivación de Genes , Humanos , Peróxido de Hidrógeno/toxicidad , Proteínas de la Membrana/genética , Proteínas de la Membrana/metabolismoRESUMEN
The fungal pathogen Candida albicans is a leading causative agent of death in immunocompromised individuals. Many factors have been implicated in virulence including filamentation-inducing transcription factors, adhesins, lipases and proteases. Many of these factors are glycosylphosphatidylinositol-anchored cell surface antigenic determinant proteins. Pga1 is one such protein shown to be upregulated during cell wall regeneration. The purpose of this study was to characterise the role Pga1 plays by creating a homozygous pga1 null strain and comparing the phenotype with the parental strain. It was observed that the mutant strain showed less oxidative stress tolerance and an increased susceptibility to calcofluor white, a cell surface disrupting agent that inhibits chitin fibre assembly which translated as a 40% decrease in cell wall chitin content. Furthermore, the mutant exhibited a 50% reduction in adhesion and a 33% reduction in biofilm formation compared with the parental strain, which was reflected as a slight reduction in virulence. Our data suggest that Pga1 plays an important role in cell wall rigidity and stability. It was also observed that the pga1 null was over filamentous on both liquid and solid media and exhibited increased resistance to SDS suggesting upregulation of filamentation-inducing genes and cell surface components to partially compensate for the deletion.
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Biopelículas/crecimiento & desarrollo , Candida albicans/fisiología , Adhesión Celular , Proteínas Fúngicas/metabolismo , Proteínas de la Membrana/metabolismo , Factores de Virulencia/metabolismo , Animales , Candida albicans/genética , Candidiasis/microbiología , Candidiasis/mortalidad , Candidiasis/patología , Línea Celular Tumoral , Pared Celular/química , Proteínas Fúngicas/genética , Eliminación de Gen , Humanos , Proteínas de la Membrana/genética , Ratones , Ratones Endogámicos BALB C , Análisis de Supervivencia , Virulencia , Factores de Virulencia/genéticaRESUMEN
AIM: To assess the appropriateness of the indication and route of administration of proton-pump-inhibitors (PPIs) and their associated cost impact. METHODS: Data collection was performed prospectively during a 6-mo period on 340 patients who received omeprazole intravenously during their hospital stay in non-intensive care floors. Updated guidelines were used to assess the appropriateness of the indication and route of administration. RESULTS: Complete data collection was available for 286 patients which were used to assess intravenous (IV) PPIs utilization. Around 88% of patients were receiving PPIs for claimed stress ulcer prophylaxis (SUP) indication; of which, only 17% met the guideline criteria for SUP indication, 14% met the criteria for non-steroidal-anti-inflammatory drugs-induced ulcer prophylaxis, while the remaining 69% were identified as having an unjustified indication for PPI use. The initiation of IV PPIs was appropriate in 55% of patients. Half of these patients were candidates for switching to the oral dosage form during their hospitalization, while only 36.7% of these patients were actually switched. The inappropriate initiation of PPIs via the IV route was more likely to take place on the medical floor than the surgical floor (53% vs 36%, P = 0.003). The cost analysis associated with the appropriateness of the indication for PPI use as well as the route of administration of PPI revealed a possible saving of up to $17,732.5 and $14,571, respectively. CONCLUSION: This study highlights the over-utilization of IV PPIs in non-intensive care unit patients. Restriction of IV PPI use for justified indications and route of administration is recommended.
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Antiulcerosos , Úlcera Duodenal , Infusiones Intravenosas/economía , Omeprazol , Inhibidores de la Bomba de Protones , Adulto , Anciano , Antiinflamatorios no Esteroideos/economía , Antiinflamatorios no Esteroideos/uso terapéutico , Antiulcerosos/administración & dosificación , Antiulcerosos/economía , Antiulcerosos/uso terapéutico , Análisis Costo-Beneficio , Úlcera Duodenal/tratamiento farmacológico , Úlcera Duodenal/economía , Femenino , Unidades Hospitalarias/economía , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Omeprazol/administración & dosificación , Omeprazol/economía , Omeprazol/uso terapéutico , Estudios Prospectivos , Inhibidores de la Bomba de Protones/administración & dosificación , Inhibidores de la Bomba de Protones/economía , Inhibidores de la Bomba de Protones/uso terapéuticoRESUMEN
BACKGROUND: Venous thromboembolism (VTE) is a major cause of death among hospitalized patients. Many VTE prophylaxis guidelines have been developed, including the American College of Chest Physicians (ACCP). VTE prophylaxis is required in specific patients; however, its practice is not always optimal, and often depends on the hospitals' protocols. In Lebanon, information about the appropriateness of VTE prophylaxis in health care centers is lacking. OBJECTIVE: The primary objective of this study was to evaluate the pattern of VTE prophylaxis application, including agents, doses, duration of treatment, and route of administration, in Lebanese health care centers. METHODS: A Lebanese multi-center, prospective, chart review study was conducted over 4 months. Data on demographics, VTE prophylaxis medication, dose, route, duration, and associated risk factors were collected by pharmacy students. The appropriateness of VTE prophylaxis was determined as per ACCP guidelines. Patients receiving VTE treatment were excluded from the study. Institutional review board (IRB) approval was obtained from each hospital center. RESULTS: A total of 840 patients were included. Both gender groups were equally represented in the sample and the mean age was 59 +/- 19.53 years. The majority (639/840, 76.1%) of the sample were at high risk for deep venous thrombosis (DVT), and inappropriate VTE prophylaxis was reported in 35% of the low-risk group, in 70% of the moderate-risk group, and in 39% of the high-risk group (P < 0.0001). Comparing proper VTE prophylaxis practice between intensive care unit (ICU) and non-ICU patients, there was no statistical difference observed in teaching hospitals (67.2% vs. 65.5%, P = 0.312). However, in non-teaching hospitals, appropriate VTE prophylaxis practice was more prevalent in ICU than non-ICU patients (65.9% vs. 51.2%, P = 0.004). The average duration of VTE prophylaxis was less than 10 days. Missing data was a major limitation for this study, where, for instance, the duration of prophylaxis could not be accurately abstracted in half of the sample. Another limitation was the absence of laboratory results needed for clinical assessment of the regimen used. CONCLUSION: This study reflected the importance of assessing VTE prophylaxis in Lebanese hospitals, thus, the need for implementing established guidelines to improve the overall patient safety.
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Evaluación de Procesos, Atención de Salud , Tromboembolia Venosa/prevención & control , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Adhesión a Directriz , Humanos , Líbano , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Embarazo , Complicaciones Cardiovasculares del Embarazo , Estudios Prospectivos , Insuficiencia Renal/complicaciones , Tromboembolia Venosa/complicaciones , Adulto JovenRESUMEN
Physician characteristics and preferences continue to change. Between 1970 and 1999, the physician population more then doubled nationwide and the proportion of female MDs increased from 7.7% to 23.4%. This study examines the changing profile of Oklahoma physicians since 1928. Data on 14,314 MDs licensed by the Oklahoma State Board of Medical Licensure and Supervision between 1928 and 2001 were analyzed, and summary statistics on age, gender, race, specialty and board certification are reported by ten-year intervals. On average, Oklahoma physician are getting older. While the mean age in the 60s was 35 years, by the end of the last decade it had risen to 52. The number of women MDs started to increase in the 70s and has more then tripled in the last 30 years. The same pattern of growth has been witnessed for non-white physicians and international medical graduates (IMGs), who were practically non-existent before 1960. The proportion of board certified physicians has steadily increased, reaching the current level of 66%. Due to the increasing participation of females, non-whites and IMGs, the profile of the Oklahoma physician has radically changed during the last 70 years.