Patient-reported outcomes of maxillary implant-supported overdentures compared with conventional dentures

OBJECTIVE The aim of the present prospective clinical study was to compare patient-reported outcomes for maxillary conventional dentures and maxillary implant-supported dentures. MATERIAL AND METHODS Twenty-one patients (6 women and 15 men) being edentulous in the maxilla and encountering problems with their existing dentures were included. Twelve patients (4 women and 8 men) received a new set of conventional dentures, due to insufficient dentures. In nine patients (2 women and 7 men), the existing dentures were adjusted by means of relining or rebasing. All patients received implant-supported dentures on two retentive anchors. In total, 42 implants were inserted in the anterior maxilla. The participants rated their satisfaction on their existing conventional dentures, 2 months after insertion of new conventional dentures and 2 months after insertion of implant-supported dentures. Thereby, patients responded to questionnaires capturing the oral health impact profile (OHIP) using visual analog scales. Seven domains (functional limitation, physical pain, psychological discomfort, physical, psychological and social disability and handicap) were assessed. Higher scores implied poorer patient satisfaction. In addition, the questionnaire involved the evaluation of cleaning ability, general satisfaction, speech, comfort, esthetics, stability, and chewing ability. Higher scores implied higher patient satisfaction. RESULTS Patient satisfaction significantly increased for implant-supported dentures compared with old dentures in all seven OHIP subgroups, as well as for cleaning ability, general satisfaction, ability to speak, comfort, esthetics, and stability (P < 0.05). The comparison of new conventional dentures and implant-supported dentures revealed a statistically significantly increased satisfaction for functional limitation (difference of 33.2 mm), psychological discomfort (difference of 36.7 mm), physical disability (difference of 36.3 mm), and social disability (difference of 23.5 mm), (P < 0.05). Additionally, general satisfaction, chewing ability, speech, and stability significantly improved in implant-supported dentures (P < 0.05). CONCLUSIONS Within the limits of this study, maxillary dentures retained by two implants provided some significant short-term improvements over conventional dentures in oral- and health-related quality of life.

Regional Radiation Pneumonitis After SIRT of a Subcapsular Liver Metastasis: What is the Effect of Direct Beta Irradiation?

We herein present a patient undergoing selective internal radiation therapy with an almost normal lung shunt fraction of 11.5 %, developing histologically proven radiation pneumonitis. Due to a predominance of pulmonary consolidations in the right lower lung and its proximity to a large liver metastases located in the dome of the right liver lobe a Monte Carlo simulation was performed to estimate the effect of direct irradiation of the lung parenchyma. According to our calculations direct irradiation seems negligible and RP is almost exclusively due to ectopic draining of radioactive spheres.

Disastrous Portal Vein Embolization Turned into a Successful Intervention

Portal vein embolization (PVE) may be performed before hemihepatectomy to increase the volume of future liver remnant (FLR) and to reduce the risk of postoperative liver insufficiency. We report the case of a 71-year-old patient with hilar cholangiocarcinoma undergoing PVE with access from the right portal vein using a mixture of n-butyl-2-cyanoacrylate and ethiodized oil. During the procedure, nontarget embolization of the left portal vein occurred. An aspiration maneuver of the polymerized plug failed; however, the embolus obstructing portal venous flow in the FLR was successfully relocated into the right portal vein while carefully bypassing the plug with a balloon catheter, inflating the balloon, and pulling the plug into the main right portal vein.

Outcome study of real-time MR-guided cervical periradicular injection therapy in an open 1.0 Tesla MRI system

PURPOSE To evaluate the accuracy, safety, and efficacy of cervical nerve root injection therapy using magnetic resonance guidance in an open 1.0 T MRI system. METHODS Between September 2009 and April 2012, a total of 21 patients (9 men, 12 women; mean age 47.1 ± 11.1 years) underwent MR-guided cervical periradicular injection for cervical radicular pain in an open 1.0 T system. An interactive proton density-weighted turbo spin echo (PDw TSE) sequence was used for real-time guidance of the MR-compatible 20-gauge injection needle. Clinical outcome was evaluated on a verbal numeric rating scale (VNRS) before injection therapy (baseline) and at 1 week and 1, 3, and 6 months during follow-up. RESULTS All procedures were technically successful and there were no major complications. The mean preinterventional VNRS score was 7.42 and exhibited a statistically significant decrease (P < 0.001) at all follow-up time points: 3.86 ± 1.53 at 1 week, 3.21 ± 2.19 at 1 month, 2.58 ± 2.54 at 3 months, and 2.76 ± 2.63 at 6 months. At 6 months, 14.3 % of the patients reported complete resolution of radicular pain and 38.1 % each had either significant (4-8 VNRS score points) or mild (1-3 VNRS score points) relief of pain; 9.5 % experienced no pain relief. CONCLUSION Magnetic resonance fluoroscopy-guided periradicular cervical spine injection is an accurate, safe, and efficacious treatment option for patients with cervical radicular pain. The technique may be a promising alternative to fluoroscopy- or CT-guided injections of the cervical spine, especially in young patients and in patients requiring repeat injections.

Novel Nonbiologic Therapies for Ulcerative Colitis

An extensive array of compounds has been studied for the treatment of ulcerative colitis (UC). The most frequently used nonbiologic drugs for the oral and intravenous treatment of ulcerative colitis include 5-aminosalicylate (5-ASA) drugs (mesalamine and derivatives), sulfasalazine, and other azo-bonded molecules of 5-ASA, steroids, calcineurin inhibitors (cyclosporine, tacrolimus, and sirolimus), thiopurines (azathioprine, 6-mercaptopurine), and methotrexate, which are already presented in other sections of this book and are thus not considered in this chapter. The therapies presented in this section should be considered as potential alternatives, mostly for mild-to-moderate ulcerative colitis (UC). They are substances mostly used without FDA indications, such as heparin, nicotine, rosiglitazone, and N-acetylcysteine as well as “natural” compounds suggested to have anti-inflammatory or reparative properties, such as aloe vera, curcumin, short-chain fatty acids, and Bowman-Birk inhibitor

“No fim não vai ficar nada”: exploração dos recursos florestais em Cabo Delgado relatório do trabalho de campo em Namiune, Nkonga e 5º Congresso: Relatório do trabalho de campo nas concessões COMADEL e a FMJ, Cabo Delgado, Novembro de 2010

This report focuses on forest product users in the COMADEL and FMJ forest concessions, Cabo Delgado, as well as the effects of their combined strategies and activities on sustainable use of natural resources and sustainable socio-economic development of the region. The aim is to contribute to understanding the effects of these strategies and activities on forest regeneration, ecosystem services and on resource sustainability. The study examines the role played by the Committees of Natural Resources in forest exploitation. Data obtained from interviews and observations were used to complement and update a variety of existing data from oral and written sources dealing with forest regeneration in Cabo Delgado. These existing materials originate from previous studies conducted in the context of the ESAPP project that started more than two years ago. They include results from Learning for Sustainability workshops (LforS, http://www.cde.unibe.ch/Pages/Project/2/14/Learningfor- Sustainability-Extension-Approach.aspx), as well as field reports, academic studies, management plans used by concessionaires, and others. The interviews and observations took place more or less continuously from the beginning of this phase of the project in 2008. Interviews were systematically conducted with owners of concessions operating in the region, employees of logging companies, residents of villages within the existing concessions, government officials and others. It was not possible to collect information directly from poachers in part due to the illegal nature of their work. Information on these activities was obtained indirectly through members of the Committees of Natural Resources, the concessionaire, and its workers, as well as by observing the traces of extraction – traps, bones and parts of slaughtered animals, tree stumps, material ready for transportation, etc. The main results indicate that extraction by the logging company MITI Ltd. and others acting in the region, by poachers and by other actors – e.g. sawyers using manual saws – put a lot of pressure on marketable species, particularly Millettia stuhlmannii, Afzelia quanzensis and Swartzia madagascariensis. Natural regeneration of forests in northern Cabo Delgado is being compromised by the combination of various extracting activities and uncontrolled fires. MITI Ltd. continued the pattern of exploitation of forest resources that was characteristic of companies operating in the region earlier, such as COMADEL. MITI Ltd. failed to implement the broad range of development and conservation activities encouraged by the new legislation on forest concessions that was created to promote sustainable use of resources.

Burden of serious fungal infections in Tanzania.

The incidence and prevalence of fungal infections in Tanzania remains unknown. We assessed the annual burden in the general population and among populations at risk. Data were extracted from 2012 reports of the Tanzanian AIDS program, WHO, reports, Tanzanian census, and from a comprehensive PubMed search. We used modelling and HIV data to estimate the burdens of Pneumocystis jirovecii pneumonia (PCP), cryptococcal meningitis (CM) and candidiasis. Asthma, chronic obstructive pulmonary disease and tuberculosis data were used to estimate the burden of allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA). Burdens of candidaemia and Candida peritonitis were derived from critical care and/or cancer patients' data. In 2012, Tanzania's population was 43.6 million (mainland) with 1 500 000 people reported to be HIV-infected. Estimated burden of fungal infections was: 4412 CM, 9600 PCP, 81 051 and 88 509 oral and oesophageal candidiasis cases respectively. There were 10 437 estimated posttuberculosis CPA cases, whereas candidaemia and Candida peritonitis cases were 2181 and 327 respectively. No reliable data exist on blastomycosis, mucormycosis or fungal keratitis. Over 3% of Tanzanians suffer from serious fungal infections annually, mostly related to HIV. Cryptococcosis and PCP are major causes of mycoses-related deaths. National surveillance of fungal infections is urgently needed.

The high cost of inappropriate empiric treatment of presumed Clostridium difficile-associated diarrhea

The Center for Disease Control and Prevention (CDC) estimates that more than 2 million patients annually acquire an infection while hospitalized in U.S. hospitals for other health problems, and that 88,000 die as a direct or indirect result of these infections. Infection with Clostridium difficile is the most important common cause of health care associated infectious diarrhea in industrialized countries. The purpose of this study was to explore the cost of current treatment practice of beginning empiric metronidazole treatment for hospitalized patients with diarrhea prior to identification of an infectious agent. The records of 70 hospitalized patients were retrospectively analyzed to determine the pharmacologic treatment, laboratory testing, and radiographic studies ordered and the median cost for each of these was determined. All patients in the study were tested for C. difficile and concurrently started on empiric metronidazole. The median direct cost for metronidazole was $7.25 per patient (95% CI 5.00, 12.721). The median direct cost for laboratory charges was $468.00 (95% CI 339.26, 552.58) and for radiology the median direct cost was $970.00 (95% CI 738.00, 3406.91). Indirect costs, which are far greater than direct costs, were not studied. At St. Luke's, if every hospitalized patient with diarrhea was empirically treated with metronidazole at a median cost of $7.25, the annual direct cost is estimated to be over $9,000.00 plus uncalculated indirect costs. In the U.S., the estimated annual direct cost may be as much as $21,750,000.00, plus indirect costs. ^ An unexpected and significant finding of this study was the inconsistency in testing and treatment of patients with health care associated diarrhea. A best-practice model for C. difficile testing and treatment was not found in the literature review. In addition to the cost savings gained by not routinely beginning empiric treatment with metronidazole, significant savings and improvement in patient care may result from a more consistent approach to the diagnosis and treatment of all patients with health care associated diarrhea. A decision tree model for C. difficile testing and treatment is proposed, but further research is needed to evaluate the decision arms before a validated best practice model can be proposed. ^

A systematic review of literature on socioeconomic disparities in the prevalence of dental caries

Dental caries, also known as tooth decay, are a disease of the oral cavity that affects the tooth structure and leads to the occurrence of cavities in teeth. Dental caries are one of the leading chronic diseases in the population and are very common in childhood. If not treated appropriately, dental caries have debilitating effect on the oral and general health of individuals. ^ Objectives. The aims of this review are to (1) analyze and elucidate the relationship between the social and economic determinants of health like income, education and race/ethnicity and the prevalence of dental caries and (2) identify and understand the pathways/underlying causes through which these factors affect the occurrence of dental caries. This review will provide a foundation for formulation of better oral health policies in future by identifying the key socio-economic factors and pathways affecting the prevalence of dental caries. Knowledge about these socioeconomic factors could be incorporated in the design of future policies and interventions to achieve greater benefits.^ Methods. This review includes information from all pertinent articles, reviews, surveys, reports, peer reviewed literature and web sources that were published after 2000. The selection criterion includes literature focusing on individuals between the ages of 1 to 65 years, and individuals from different subgroups of community based on income, education and race/ethnicity. The analyses of literature include identifying if a relationship between income/education/race and the prevalence of dental caries exists by comparing the prevalence of dental caries in different socio-economic groups. Also included in this review are articles that are relevant to the mechanisms/pathways through which income/education/race affect the prevalence of dental caries.^ Results. Analyses of available literature suggests that disparities in the prevalence of dental caries may be attributed to differences in income, education and race/ethnicity. Higher prevalence of dental caries was observed in African-American and Mexican-American individuals, and in people with low income and low education. The leading pathways through which the socioeconomic factors affect the prevalence of dental caries are the lack of access to dental care, lack of awareness about good oral hygiene beliefs and habits, oral health, inability to afford dental care, lack of social support to maintain oral health and lack of dental insurance.^ Conclusion. Disparities in the prevalence of dental caries exist in various socio-economic groups. The relationship between socio-economic factors and dental caries prevalence should be considered in the development of future policies and interventions that are aimed at reducing the prevalence of dental caries and enhancing oral health status.^

Educación y narrativas en las periferias urbanas : Persistencias y variaciones en las culturas migrantes

El presente trabajo es un estudio sobre narraciones de niños y adolescentes de barrios de la periferia de la ciudad de La Plata, hijos y nietos de migrantes internos, que fueron producidas en el marco de talleres de lectura y escritura en espacios de educación formal y no formal. El trabajo propone indagar cómo estas narraciones retoman temas de relatos tradicionales (en particular el uso de seres sobrenaturales) y los reformulan en esos nuevos contextos de producción. Las narraciones objeto de nuestro estudio actualizan figuras típicas de los relatos orales argentinos, tales como son los seres sobrenaturales. En ese sentido se indagará qué operaciones estéticas intervienen en las narraciones, es decir, cómo se articulan figuras propias de algunas tradiciones orales argentinas en nuevos contextos narrativos. Es probable que en estas narraciones los niños y adolescentes estén dialogando con la cultura de sus mayores e inscribiendo su propia subjetividad en nuevas condiciones de producción social y cultural; en palabras de Jerome Bruner la narración permite organizar nuestra identidad y nuestra visión del estado real de las cosas (2003:23). Sin embargo, aún no nos interesa (ni podríamos desarrollar) este tipo de formulaciones: primero, se busca conocer qué uso particular se hace de los seres sobrenaturales en esas narraciones recortadas como relatos. Esa articulación es dada o habilitada por las condiciones de producción discursivas que se juegan en los espacios de enseñanza de la lengua y la literatura que han dado marco a las narraciones en cuestión. Finalmente, se analizan las complejas negociaciones que se establecen entre la larga historia del relato oral (muchos relatos, por ejemplo, provienen de culturas precolombinas) y la acto de escritura en el presente. Así, por ejemplo, se escribe que el Pomberito, quien en los relatos correntinos se presenta como un ser que exige tabaco para cuidar del hombre, ahora pide marihuana. En tal sentido, la tradición es, en parte, una traición: los relatos tradicionales se mantienen y perduran pero con transformaciones necesarias que permiten que los sujetos puedan apropiarse de ellos en nuevos otorgamientos de sentidos

Zangorromangos, bimbilindrones, chuchumbés y otros eufemismos líricos populare

Dentro de las composiciones de extracción oral y popular se destaca la utilización de algunas palabras que entrañan una enorme significación. Se trata de estribillos que funcionan como una especie de muletilla expresiva, rítmica y metafórica, aunque el sentido oculto al que remiten resulte un tanto misterioso. Estos artilugios estilísticos, a mitad de camino entre la onomatopeya, el juego de palabras e ironías y el comodín rítmico y métrico, contienen muchas veces, un doble sentido insinuante que conlleva denotaciones pícaras y sensuales, atrevidas, procaces y a veces escandalosas. Este repertorio poético, antes desatendido, persiste no como reflejo pasivo de tradiciones heredadas, sino como crisol vivo de nuevas recreaciones y reconfiguraciones que impregnan géneros, repertorios y diversos registros

Juego y tradición folklórica en una novela de Mario Vargas Llosa

La relación entre la tradición oral y la literatura escrita existe desde antiguo. En este caso, las cancioncillas, las retahílas que acompañan a este tradicional, y universal, juego infantil de Las cuatro esquinas sirven al novelista Mario Vargas Llosa como núcleo generador del relato El paraíso en la otra esquina a la vez que como epítome de la andadura vital de Paul Gauguin. Esta relación entre la vida y la canción nos permite profundizar en la historia del juego de Las cuatro esquinas desde sus orígenes hasta el siglo xxi

In memoriam : Alan Deyermond y la oralidad en la literatura medieval hispánica

La figura de Alan Deyermond fue esencial para desarrollar los congresos de Lyra Minima. La oralidad, la autoría femenina y la interacción entre lírica culta y popular han sido temas caros a su obra. Uno de sus conceptos más acertado es la de textos transicionales referidos a los que fueron producidos durante el periodo final de la Edad Media y comienzos del Renacimiento. La relación oralidad - cultura-escrita durante esa época aparece como una transformación, como una superación y como una simbiosis. A Deyermond le resulta probable que la tradición poética popular y oral comenzara canciones de mujer llena de símbolos naturales e imágenes elementales

Educación y narrativas en las periferias urbanas : Persistencias y variaciones en las culturas migrantes

El presente trabajo es un estudio sobre narraciones de niños y adolescentes de barrios de la periferia de la ciudad de La Plata, hijos y nietos de migrantes internos, que fueron producidas en el marco de talleres de lectura y escritura en espacios de educación formal y no formal. El trabajo propone indagar cómo estas narraciones retoman temas de relatos tradicionales (en particular el uso de seres sobrenaturales) y los reformulan en esos nuevos contextos de producción. Las narraciones objeto de nuestro estudio actualizan figuras típicas de los relatos orales argentinos, tales como son los seres sobrenaturales. En ese sentido se indagará qué operaciones estéticas intervienen en las narraciones, es decir, cómo se articulan figuras propias de algunas tradiciones orales argentinas en nuevos contextos narrativos. Es probable que en estas narraciones los niños y adolescentes estén dialogando con la cultura de sus mayores e inscribiendo su propia subjetividad en nuevas condiciones de producción social y cultural; en palabras de Jerome Bruner la narración permite organizar nuestra identidad y nuestra visión del estado real de las cosas (2003:23). Sin embargo, aún no nos interesa (ni podríamos desarrollar) este tipo de formulaciones: primero, se busca conocer qué uso particular se hace de los seres sobrenaturales en esas narraciones recortadas como relatos. Esa articulación es dada o habilitada por las condiciones de producción discursivas que se juegan en los espacios de enseñanza de la lengua y la literatura que han dado marco a las narraciones en cuestión. Finalmente, se analizan las complejas negociaciones que se establecen entre la larga historia del relato oral (muchos relatos, por ejemplo, provienen de culturas precolombinas) y la acto de escritura en el presente. Así, por ejemplo, se escribe que el Pomberito, quien en los relatos correntinos se presenta como un ser que exige tabaco para cuidar del hombre, ahora pide marihuana. En tal sentido, la tradición es, en parte, una traición: los relatos tradicionales se mantienen y perduran pero con transformaciones necesarias que permiten que los sujetos puedan apropiarse de ellos en nuevos otorgamientos de sentidos

Zangorromangos, bimbilindrones, chuchumbés y otros eufemismos líricos populare

Dentro de las composiciones de extracción oral y popular se destaca la utilización de algunas palabras que entrañan una enorme significación. Se trata de estribillos que funcionan como una especie de muletilla expresiva, rítmica y metafórica, aunque el sentido oculto al que remiten resulte un tanto misterioso. Estos artilugios estilísticos, a mitad de camino entre la onomatopeya, el juego de palabras e ironías y el comodín rítmico y métrico, contienen muchas veces, un doble sentido insinuante que conlleva denotaciones pícaras y sensuales, atrevidas, procaces y a veces escandalosas. Este repertorio poético, antes desatendido, persiste no como reflejo pasivo de tradiciones heredadas, sino como crisol vivo de nuevas recreaciones y reconfiguraciones que impregnan géneros, repertorios y diversos registros