Protocol For Management Of Patients Research Articles

A personalized approach to the treatment of chronic tension-type headache: quality of life of patients

Objective: to evaluate the quality of life in a personalized approach to the treatment of chronic tension-type headache (CTTH) in comparison with a standard treatment protocol.Material and methods. The study involved 61 patients with CTTH. Patients were randomly divided into two groups. The first (main) group consisted of patients (n=30) who received a personalized approach with a psychotherapist contributing to the treatment. The comparison group consisted of patients (n=31) who were treated according to a standard protocol with counselling and observation by a neurologist. Pain intensity was assessed using the visual analogue pain scale (VAS). The SF-36 questionnaire was used to assess quality of life. Differences between the groups were analyzed by assessing individual changes in eight different domains of the SF-36 questionnaire for each patient.Results. In the main group, parameters characterizing the physical (pain intensity) and emotional experience of the pain (mental health, social functioning, life activity; p<0.05) decreased after 6 months of treatment when a personalized approach to the treatment of CTTH was applied, compared to the control group (with a standard patient management protocol).Conclusion. The personalized approach showed an improvement of the quality of life of patients with CTTH compared with the standard protocol, allowing us to recommend it for a wider application in clinical practice.

Reintroduction of excluded food triggers as a crucial step in managing patients with food allergies

Introduction. Despite active research into the mechanisms of food allergies (FA), the main approach to managing patients with this condition remains the complete exclusion of causative allergens from the diet for a certain period. At the same time, the question of timely reintroduction of excluded food triggers into the diet is frequently raised, which is important both for maintaining oral tolerance and reducing the negative effects of long-term elimination diets, such as nutritional and eating behavior disorders, as well as financial burdens on families. However, clear recommendations on the reintroduction of previously excluded foods have not existed until recently. Regarding cow’s milk protein allergy (CMPA), such recommendations were provided in 2023 in the consensus document of the World Allergy Organization (WAO) — DRACMA.Aim. The aim of this review is to present current approaches to the reintroduction of food allergens into the diets of patients with food allergies and to evaluate various reintroduction protocols, including those used for cow’s milk protein allergy (CMPA).Material and methods. This review provides a concise summary of current approaches to reintroducing food allergens into the diet, covering both IgE-mediated and non-IgE-mediated forms of food allergy. The advantages of different patient management protocols are discussed, with special attention given to CMPA as one of the most common manifestations of FA in children.Results. An analysis of modern approaches has demonstrated that modern recommendations regarding the reintroduction of allergens, including those presented in the document of the World Allergological Organization — DRACMA for allergy to cow’s milk proteins, allow for a more personalized and safe approach to the reintroduction of allergens, which helps reduce risks and maintain food tolerance.Conclusions. The introduction of new guidelines for the reintroduction of food allergens is an important step in managing patients with food allergies. These recommendations provide a more personalized approach to treating food-allergic patients, including those with cow’s milk protein allergy, reducing the risks associated with reintroducing allergens into the diet. They also help to mitigate the negative effects of elimination diets and maintain oral tolerance in patients, which is particularly important for children with FA.

Best Patient Care Practices for Administering PSMA-Targeted Radiopharmaceutical Therapy.

Optimal patient management protocols for metastatic castration-resistant prostate cancer (mCRPC) are poorly defined and even further complexified with new therapy approvals, such as radiopharmaceuticals. The prostate-specific membrane antigen (PSMA)-targeted agent 177Lu vipivotide tetraxetan ([177Lu]Lu-PSMA-617), approved after the phase III VISION study, presents physicians with additional aspects of patient management, including specific adverse event (AE) monitoring and management, as well as radiation safety. Drawing on our experience as VISION study investigators, here we provide guidance on best practices for delivering PSMA-targeted radiopharmaceutical therapy (RPT) to patients with mCRPC. After a comprehensive review of published evidence and guidelines on RPT management in prostate cancer, we identified educational gaps in managing the radiation safety and AEs associated with [177Lu]Lu-PSMA-617. Our results showed that providing sufficient education on AEs (e.g., fatigue and dry mouth) and radiation safety principles is key to effective delivery and management of patient expectations. Patient counseling by health care professionals, across disciplines, is a cornerstone of optimal patient management during PSMA-targeted RPT. Multidisciplinary collaboration is crucial, and physicians must adhere to radiation safety protocols and counsel patients on radiation safety considerations. Treatment with [177Lu]Lu-PSMA-617 is generally well tolerated; however, additional interventions may be required, such as dosing modification, medications, or transfusions. Urinary incontinence can be challenging in the context of radiation safety. Multidisciplinary collaboration between medical oncologists and nuclear medicine teams ensures that patients are monitored and managed safely and efficiently. In clinical practice, the benefit-to-risk ratio should always be evaluated on a case-by-case basis.

A-152 Enhancing PNH Diagnosis with Multicolor Flow Cytometry Immunophenotyping Protocol in a Medical Center in Taiwan

Abstract Background Paroxysmal Nocturnal Hemoglobinuria (PNH) is a rare hematopoietic stem cell disorder resulting from mutations in the X-linked PIG-A gene, leading to an inability to produce GPI-anchored proteins on RBCs and WBCs. PNH presents in three variants: classic (hemolytic), associated with specified bone marrow disorders, and subclinical. Flow cytometric analysis stands as the gold standard for PNH detection, crucial in diagnosis, monitoring, and clinical management. Recognizing potential variations in PNH testing among labs, it is essential to establish a precise and consistent protocol for accurate diagnosis and patient management. This report aims to demonstrate the effectiveness of a PNH immunophenotyping protocol adhering to ICCS/ESCCA PNH consensus guidelines. Methods A total of 501 samples were analyzed from Jan 1st, 2021 to Dec 31st, 2023. All the acquisitions were accomplished by a 3-laser and 10-PMT Navios EX (Beckman Coulter) flow cytometry. A typical combination of anti-CD235a-FITC (clone KC16) and anti-CD59-PE (clone MEM43) antibodies were adopted to identify the PNH clone size in the RBC tube. To achieve higher sensitivities in PNH granulocyte and PNH monocyte detection, a single tube, 6-color mixture of FLAER, monoclonal antibodies including CD14-APC, CD24-PE, CD33-APC-H7, CD15-PacB, and CD45-KrO, to immunostaining simultaneously was developed. An unstained control was run after the full-stained tube to determine the position of threshold for positivity, and to exam the potential carryover into the test sample. Results RBC and granulocyte assays can detect PNH phenotypes at the 0.009% level or higher with more than 50,000 cells of gated cells acquired, while the monocyte assay can detect at >=0.069% with at least 20,000 cells acquired. Analysis was conducted on five hundred and one patients to investigate potential PNH clones in their blood cells. Among them, 45 patients were identified as having classic PNH, while PNH clones were not detected in 168 cases, constituting 33.5% of total cases. Minor PNH clone (<1.0%) in single cell lineage were observed in 144 cases, making up 28.7% of all cases. Minor PNH clones found in more than one cell lineages were found in 155 cases (30.9% of 501). Additionally, minor PNH clones were identified across RBCs, granulocytes, and monocytes, with percentages of 32.9%, 23.8%, and 43.9%, respectively of all patients. Notably, monocyte clones exceeded granulocyte clones in 23.0% of cases with WBC PNH clones, irrespective of clone sizes. Furthermore, we investigated seven patients exhibiting persistent minor PNH clones in 2 to 3 cell lineages. Among them, five had aplastic anemia or myelodysplastic syndromes, while one underwent evaluation for young stroke and one was investigated for venous thromboembolism. Conclusions Flow cytometry labs aim not only to identify classic PNH patients but also to consistently detect minor or small clones in individuals with bone marrow disorders or subclinical conditions. Our findings are compatible with international reports, underscoring the importance of routinely examining patients with minor clones. Such assays serve as essential tools for ongoing monitoring, facilitating PNH diagnosis and management by physicians.

Role of empirical antitubercular therapy for chronic mastitis—A prospective study

Objectives Chronic mastitis (CM) is an uncommon inflammatory condition of the breast, clinically mimicking malignancy with variable etiological factors. It often recurs, causing cosmetic disfigurement and hampering the quality of life of affected females. Limited literature reveals underlying bacterial infection as causative agents in a few cases, while the majority belong to idiopathic entities. CM can be seen as two histological types—chronic granulomatous mastitis (CGM) and chronic nonspecific inflammatory infiltrates (NGM). Etiological and ethnic variations exist globally, and there is lack of information from India. Understanding this entity is important for undertaking etiology-based therapy and preventing unnecessary mismanagement. Materials and Methods We evaluated the demographic, imaging profile and management protocol of CM patients presenting to a tertiary care center in India. Clinically suspected CM patients were prospectively evaluated by mammography and ultrasound (USG). USG-guided biopsy was performed for histopathological and microbiological analysis and treatment was administered accordingly. Response assessment was conducted at six months through USG and clinical evaluation. Results Out of the 53 clinically suspected CM patients, 48 biopsy-proven CM patients were enrolled (five breast carcinoma cases were excluded). All 48 patients were females, with a mean age of 36 ± 9 years. The most common symptom was a unilateral painful lump with skin discoloration. The etiology was idiopathic in 58.3% of cases, tuberculosis in 29%, and bacterial in 4%. Mammography revealed focal asymmetry, architectural distortion, and trabecular thickening. USG showed tracking fluid collections, microlobulated hypoechoic masses, and skin thickening. Etiology-based treatment was administered, and all patients showed 90–100% resolution between four and six months. Conclusion Mammography and USG are important for raising the suspicion while histopathology and microbiological analysis are mandatory for accurate treatment of CM. In India, idiopathic and tubercular etiology of CM is encountered and patients respond well to therapy.

Diagnostic Musculoskeletal Ultrasound for Medial Collateral Ligament Injuries: Applications in Rehabilitation.

Medial collateral ligament (MCL) injuries are prevalent in sports and other physical activities and constitute a significant cause of knee pain and dysfunction. Traditional diagnostic modalities such as magnetic resonance imaging (MRI) are often utilized for their detailed visualization capabilities. However, musculoskeletal ultrasound (MSK-US) has emerged as a pivotal diagnostic tool in the evaluation of MCL injuries due to its non-invasive nature, cost-effectiveness, and dynamic imaging capabilities. This article reviews the utility and advantages of MSK-US in diagnosing MCL injuries, with a specific focus on its implications for rehabilitation providers. We discuss the technical aspects of ultrasound (US) imaging, including the sonographic appearance of MCL injuries across various grades, and compare its diagnostic accuracy with other imaging modalities such as MRI. Additionally, the role of US in monitoring the healing process and guiding rehabilitation strategies is explored. This review emphasizes the practical application of MSK-US in clinical settings, offering rehabilitation providers a comprehensive understanding of how US can be integrated into patient management protocols to enhance outcomes in patients with MCL injuries.

Implementing Massive Parallel Sequencing into Biliary Samples Obtained through Endoscopic Retrograde Cholangiopancreatography for Diagnosing Malignant Bile Duct Strictures.

Despite advancements in radiologic, laboratory, and pathological evaluations, differentiating between benign and malignant bile duct strictures remains a diagnostic challenge. Recent developments in massive parallel sequencing (MPS) have introduced new opportunities for early cancer detection and management, but these techniques have not yet been rigorously applied to biliary samples. We prospectively evaluated the Oncomine Comprehensive Assay (OCA) and the Oncomine Pan-Cancer Cell-Free Assay (OPCCFA) using biliary brush cytology and bile fluid obtained via endoscopic retrograde cholangiopancreatography from patients with bile duct strictures. The diagnostic performance of MPS testing was assessed and compared to the pathological findings of biliary brush cytology and primary tissue. Mutations in TP53, BRAF, CTNNB1, SMAD4, and K-/N-RAS identified in biliary brush cytology samples were also detected in the corresponding bile fluid samples from patients with extrahepatic cholangiocarcinoma. These mutations were also identified in the bile fluid samples, but with variant allele frequencies lower than those in the corresponding biliary brush cytology samples. In control patients diagnosed with gallstones, neither the biliary brush cytology samples nor the bile fluid samples showed any pathogenic mutations classified as tier 1 or 2. Our study represents a prospective investigation into the role of MPS-based molecular testing in evaluating bile duct strictures. MPS-based molecular testing shows promise in identifying actionable genomic alterations, potentially enabling the stratification of patients for targeted chemotherapeutic treatments. Future research should focus on integrating OCA and OPCCFA testing, as well as similar MPS-based assays, into existing surveillance and management protocols for patients with bile duct strictures.

Impression fracture of the lateral condyle of tibial plateau complicated by acute peri-implant infection: a case report

Introduction. Deep infection after open osteosynthesis of tibial plateau fractures occurs in 9.9%. This rate is significantly higher than in surgical treatment of closed injuries of other localizations. Many authors consider it necessary to improve management protocols for patients with complex plateau fractures in order to minimize or prevent the development of infectious complications. Aims of the study: 1) to discuss the treatment tactics of a patient with an intraarticular fracture of the tibial plateau after osteosynthesis complicated by the development of early deep surgical site infection (SSI), using clinical case as an example; 2) to carry out the analysis of medical care defects. Case description. A 71-year-old patient with compromised somatic status underwent osteosynthesis with a buttress plate and allogeneic bone grafting of the metaphyseal defect on the 12th day after injury. In 7 days after the occurrence of signs of infection, a revision surgery was performed. Later, a number of consecutive revisions were performed due to recurrences of the infectious process. The complex of measures against SSI included the use of vacuum drainage systems and antibacterial spacers. As a result, the wounds had healed. Two years after the injury, the patient had a good functional result. Conclusion. The presented clinical case has shown that even if the treatment tactic for early peri-implant infection is chosen correctly, there are several defects in our routine practice. First of all, inaccurate sampling of material for bacteriological study and inadequate duration of antibacterial therapy are to be mentioned. To successfully treat infectious complications of osteosynthesis, a team of like-minded specialists including traumatologists as well as physicians, microbiologists and clinical pharmacologists is needed. Undoubtedly, surgical treatment of fractures might develop into infectious complications. Their diagnosis and treatment are often accompanied by a number of various mistakes. The most important points are early radical revision of the postoperative wound, etiotropic antibacterial therapy, maintaining stability of fixation after primary osteosynthesis. If these standards are complied with, the outcome of surgical treatment might be satisfying even with such a severe complication as peri-implant infection. At the same time, we are planning further researches aimed at improving algorithms and tactics for surgical treatment of infectious complications, reducing surgery trauma level and upgrading quality of primary osteosynthesis.

The heart of it: dental care and cardiothoracic surgery.

Both dental and cardiovascular disease are prevalent in the general population, have common risk factors and may be closely associated.Following cardiothoracic surgery, patients may be higher risk for developing infective endocarditis (IE) than the general population. Before cardiothoracic interventions, it is common practice for a dental assessment to be carried out and any necessary dental treatment provided. This aims to reduce the risk of IE arising from dental sources and avoid dental pain or infection during the peri- and post-operative period. There is little guidance on which treatments should be performed and when.Many patients with cardiac disease may have dental treatment provided safely in primary care. However, there is often a need to consider additional factors, including bleeding risk, condition stability or medication interactions. Dental teams must have an awareness of the implications of cardiac disease and provide reasonable adjustments to care provision where necessary, ensuring patient safety.This article proposes a protocol for dental management of patients awaiting cardiothoracic surgery and explores important considerations for dental care in this patient group.

Artificial intelligence-based quantification of COVID-19 pneumonia burden using chest CT

AbstractDuring the coronavirus disease 2019 (COVID-19) pandemic, artificial intelligence (AI) based software on chest computed tomography (CT) imaging has proven to have a valuable role in accelerating diagnosis and screening. The proposed AI-based tools proved to be rapid and reproducible techniques to guide patient management and treatment protocols. Although no specific guidelines exist, CT-imaging and clinical features are used for patient staging. To shed light on the role of AI techniques that have been developed in fighting COVID-19, in this review, studies investigating the usage of commonly used AI models on chest CT imaging for disease quantification and prognostication are collected.

Unraveling the Dual Role of Voriconazole as an Antifungal Agent and Precursor to Squamous Cell Carcinoma

Voriconazole, a potent triazole antifungal medication, is extensively used to treat serious fungal infections in immunocompromised patients. Despite its efficacy, recent findings suggest a potential link between long-term voriconazole therapy and the development of squamous cell carcinoma (SCC). This review examines the dual role of voriconazole, emphasizing both its therapeutic benefits and carcinogenic risks. The pharmacodynamics of voriconazole involve the inhibition of ergosterol synthesis, crucial to fungal cell integrity. However, its metabolites, such as voriconazole-N-oxide, have been implicated in phototoxic reactions that lead to DNA damage and tumor formation. This is particularly significant in patients with prolonged drug exposure, such as organ transplant recipients, where increased SCC incidence has been observed. Clinical evidence and molecular studies suggest that voriconazole may disrupt key cellular pathways like the Hedgehog pathway, affecting epidermal differentiation and increasing cancer risk. Given these concerns, the necessity for careful therapeutic monitoring and patient education about potential risks is discussed. Alternative antifungal therapies and protective measures against phototoxic effects are also recommended as strategies to mitigate SCC risk. Future research should focus on understanding the mechanisms of voriconazole-induced carcinogenesis and refining patient management protocols. This review highlights the need for a balanced approach to voriconazole therapy, weighing its antifungal benefits against the risks of adverse dermatological outcomes.

Gestion des patients avec protéine C réactive élevée après chirurgie colorectale élective : étude pilote sur une attitude diagnostique et thérapeutique proactive (GESPACE)

Study objective. To evaluate the feasibility and benefit of a diagnostic and therapeutic algorithm for management of patients presenting with a high C-reactive protein (CRP) level after colorectal surgery.Patients and methods. Prospective study including patients with CRP > 125 mg/L at the 4th postoperative day following elective colorectal surgery. The protocol involved CT-scan of which the results were to orient subsequent management: antibiotics, radiological drainage, endoscopy or surgical redo. Success (primary endpoint) consisted in the proportion of patients with total duration of hospitalization fewer than 15 days. Secondary endpoints were: applicability of the protocol in real-life conditions, number of stomas created, duration of hospitalization in an intensive care unit.Results. One hundred and six (106) patients were included: 51 patients (48%) presented with postoperative complications, of which 21 (41%) were severe. No death occurred. Among the included patients, 68% had a hospital stay < 15 days. Major deviations from the management algorithm occurred in 38% of cases. Early endoscopy was not applicable. There was no significant difference with regard to the secondary endpoints according to whether or not the protocol was strictly observed.Conclusion. It is necessary to define a protocol for management of patients presenting with high CRP levels after colorectal surgery, the objective being to reduce the impact of complications and to avoid excessive lengthening of hospital stay. The protocol begins with CT-scan, which is to orient subsequent management.

Dedicated anticoagulation management protocols in fragility femoral fracture care – a source of significant variance and limited effectiveness in improving time to surgery: The hip and femoral fracture anticoagulation surgical timing evaluation (HASTE) study

IntroductionApproximately 20 % of femoral fragility fracture patients take anticoagulants, typically warfarin or Direct Oral AntiCoagulant (DOAC). These can impact timing of surgery affecting patient survival. Due to several possible approaches and numerous factors to consider in the preoperative workup of anticoagulated patients, potential for variations in clinical practice exist. Some hospitals employ dedicated anticoagulation management protocols to address this issue, and to improve time to surgery. This study aimed to determine the proportion of hospitals with such protocols, compare protocol guidance between hospitals, and evaluate the effectiveness of protocols in facilitating prompt surgery. MethodsData was prospectively collected through a collaborative, multicentre approach involving hospitals across the UK. Femoral fragility fracture patients aged ≥60 years and admitted to hospital between 1st May to 31st July 2023 were included. Information from dedicated anticoagulation management protocols were collated on several domains relating to perioperative care including administration of reversal agents and instructions on timing of surgery as well as others. Logistic regression was used to evaluate effects of dedicated protocols on time to surgery. ResultsDedicated protocols for management of patients taking warfarin and DOACs were present at 41 (52.6 %) and 43 (55.1 %) hospitals respectively. For patients taking warfarin, 39/41 (95.1 %) protocols specified the dose of vitamin k and the most common was 5 milligrams intravenously (n=21). INR threshold values for proceeding to surgery varied between protocols; 1.5 (n=28), 1.8 (n=6), and 2 (n=6). For patients taking DOACs, 35/43 (81.4 %) and 8/43 (18.6 %) protocols advised timing of surgery based on renal function and absolute time from last dose respectively. Analysis of 10,197 patients from 78 hospitals showed fewer patients taking DOACs received surgery within 36 h of admission at hospitals with a dedicated protocol compared to those without (adjusted OR 0.73, 95% CI 0.54–0.99, p=0.040), while there were no differences among patients taking warfarin (adjusted OR 1.64, 95% CI 0.75–3.57, p=0.219). ConclusionsAround half of hospitals employed a dedicated anticoagulation management protocol for femoral fragility fracture patients, and substantial variation was observed in guidance between protocols. Dedicated protocols currently being used at hospitals were ineffective at improving the defined targets for time to surgery.

Management of patients with high C-reactive protein levels after elective colorectal surgery: Pilot study on a proactive diagnostic and therapeutic approach (GESPACE)

To evaluate the feasibility and benefit of a diagnostic and therapeutic algorithm for management of patients presenting with a high C-reactive protein (CRP) level after colorectal surgery. Prospective study including patients with CRP>125mg/L at the 4th postoperative day following elective colorectal surgery. The protocol involved CT-scan of which the results were to orient subsequent management: antibiotics, radiological drainage, endoscopy or surgical redo. Success (primary endpoint) consisted in the proportion of patients with total duration of hospitalization fewer than 15d. Secondary endpoints were: applicability of the protocol in real-life conditions, number of stomas created, duration of hospitalization in an intensive care unit. One hundred and six (106) patients were included: 51 patients (48%) presented with postoperative complications, of which 21 (41%) were severe. No death occurred. Among the included patients, 68% had a hospital stay<15d. Major deviations from the management algorithm occurred in 38% of cases. No patients had an early endoscopy. There was no significant difference with regard to the secondary endpoints according to whether or not the protocol was strictly observed. It is necessary to define a protocol for management of patients presenting with high CRP levels after colorectal surgery, the objective being to reduce the impact of complications and to avoid excessive lengthening of hospital stay. The protocol begins with CT-scan, which is to orient subsequent management.

#1112 A simplified lung ultrasound guided management protocol of pulmonary congestion in hemodialysis

Abstract Background and Aims Pulmonary congestion PC is frequent in Hemodialysis HD and holds a negative prognostic value. Lung ultrasound LUS is accurate in detecting and quantification PC, however, there are many methods to use LUS to evaluate PC. Here we validate a simplified LUS guided pulmonary congestion management protocol in HD patients that can be easily integrated in clinical practice, while studying at the same time the impact of such method on blood pressure control. Methods A prospective randomized multi-centric trial including stable HD patients in 3 countries. Patients were randomized into two groups: active and control group. All patients had a bedside LUS at the end of their mid-week session every two weeks according to the following time-line: Day 1, 15, 30, 45, 60. Lung ultrasound was performed according to the 8-zone method, and a B line score BLS was obtained. A global BLS of more than 6 was considered reflecting a significant PC level. The dry weight was adapted according to the standard of care in the control group. In the active group, in addition to the standard of care, if BLS was more than 6 at day 1 then the dry weight was reduced by 500 g. The same procedure was repeated at Day 15. (The maximum global dry weight modification per patient was 1 kg) (Fig. 1). Home blood pressure monitoring HBPM was also obtained weekly all through the study period. Results 28 stable HD patients (21 males) were enrolled in the study up until now. Mean age was 66.4 years, 14 were diabetics, 4 with stable ischemic heart disease, 1 heart failure and 27 were suffering from hypertension. Mean dialysis vintage was 35.8 months, and mean residual urine volume was 548 ml/24H. Mean session time was 4 hours. Main study population characteristics are described in Table 1. In the active group, mean BLS at day 1 (13.5) was significantly reduced, and reached (7.57) at day 60. (P &amp;lt; 0.001, ES:1.55) (Fig. 2). This was in parallel with a little but significant reduction in the dry weight (P: 0.03, ES: 0.6) but without a statistically greater UF values (P: 0.23) (Table 2). A significant reduction in home blood pressure was also observed by the HBPM readings, especially in the diastolic BP (P: 0.004). In the control group, the mean BLS at day 1 was (12.1). This level did not change all through the study time line, as it was (12.1) at day 60. No significant difference was observed in the dry weight, or ultrafiltration rate UF or home blood pressure values (Table 3). Conclusion Our simplified LUS guided management protocol was able to safely reduce the pulmonary congestion in HD patients in addition to better controlling their blood pressure. This protocol can be applied easily in every HD unit, and may be added to the standard of care to better estimate the dry weight in HD patients.

Dental Management of patient with Parkinson’s Disease

Background: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder. This disease affects about 1 in 1000 people in the general population and 1% of the over 60 age group. The main features of the disease are: resting tremor, bradykinesia, postural instability, muscle rigidity and inexpressible face (mask-like face). People with PD face a series of pathological manifestations from the oromaxillofacial region related to the disease, while some of the drugs used to treat PD also lead to adverse effects from the oral cavity. Purpose: The dentist should be able to recognize the basic signs and symptoms of the disease, its basic oral manifestations and the basic dental management protocols of patients with PD. This review aims to contribute in this direction. Method: In pubmed database we searched with keywords “dental and Parkinson’s disease”, “Parkinson disease and dental management”, ‘Parkinson and periodontal’, “oral hygiene and Parkinson disease’, “periodontitis and Parkinson’s disease”. We concluded that 141 papers were to be used in our review. We also used Little’s and Scully’s books on the medically compromised patient, as well as Dougall’s series of articles for disabled patients. Last, we used few website links of official dental sites. Conclusion: PD patients may suffer from a multitude of pathological manifestations from the oral-maxillofacial area, while they need special dental management due to motor, mental and autonomic neural system disorders. The insufficient experience and training of the majority of dentists in treating patients with PD is given. The dental community in collaboration with the medical community and the State is important to contribute to the improvement of the oral health of PD patients, by educating patients and dentists.

Iatrogenic aortic dissection in patients undergoing coronary artery bypass grafting surgery: A systemic review of published literatures.

Iatrogenic aortic dissection (IAD) is a rare but highly lethal complication that may occur following coronary artery bypass grafting (CABG) surgery. Aortic dissection (AD) is often asymptomatic, making early detection difficult. We aimed to optimize preoperative evaluation strategies of CABG surgery for minimizing the incidence of IAD and assess early recognition and management of IAD for improving outcomes. Electronic databases were searched to identify all case reports of patients undergoing CABG surgery who developed IAD. Clinical characteristics, operative information, perioperative management, and patient outcomes were compiled and analyzed. Nineteen case reports involving 27 patients aged 50 to 81 were included. Patients were from Europe (n = 23) and Asia (n = 4), mostly men (n = 25). The aorta was described as normal, abnormal, and unmentioned (n = 8, 5, and 14, respectively). Sixteen patients had a bypass with more than 3 grafts. Most patients (n = 25) experienced type A dissection. There were intraoperative (n = 12) and postoperative (n = 15) cases. Surgery (n = 19) was the most common treatment, with 9 patients selecting deep hypothermic circulatory arrest. Eighteen patients were restored to health, while 9 patients died (3 died before treatment). Our study focused on patients with IAD and developed a recommended management protocol for patients undergoing CABG surgery.

Sustained mitigation of ST-segment elevation in a patient with Brugada syndrome type 1 during sevoflurane and remifentanil anesthesia: a case report

BackgroundDuring general anesthesia, patients with Brugada syndrome are at risk of malignant arrhythmias following worsened ST-segment elevation, potentially leading to sudden cardiac death. The protocol for safe anesthetic management of patients with Brugada syndrome has not yet been established.Case presentationA 63-year-old man, diagnosed with a spontaneous Brugada type 1 pattern, was scheduled for a pleural biopsy using video-assisted thoracoscopic surgery under general anesthesia. We planned general anesthesia using volatile induction and maintenance anesthesia with sevoflurane and remifentanil. We monitored ST-segment morphology and observed sustained mitigation of ST-segment elevation throughout general anesthesia.ConclusionThe present case may indicate that safe anesthetic management of patients with Brugada syndrome depends on whether the anesthetics used can reduce ST-segment elevation.

Implementation of a Standardized Management Protocol Improved the Survival of Patients with Necrotizing Fasciitis

Abstract Background Necrotizing fasciitis (NF) is a life-threatening soft tissue infection requiring urgent interventions. This study aimed to investigate the effect of implementation of a standardized management protocol on the outcome of NF patients admitted to the intensive care unit. Methods We initiated a management protocol for NF patients in 2012 at our institution. The protocol consisted of early surgical intervention, initial board-spectrum antibiotic regimen, daily wound inspection, repeated debridement, and inter-professional collaboration. Herein, we reviewed the NF cases admitted between 2005 and 2018 and compared their clinical features and outcome before and after the protocol implementation. All of the NF cases underwent were confirmed by intraoperative findings. Results We included 134 NF patients before (2005 to 2011, n = 62) and after (2013 to 2018, n = 72) the protocol implementation. The baseline patient profile from these two periods were largely similar, except that after protocol implementation, more patients presented with erythema (64.5% vs 84.7%) and a higher C-reactive protein level (65.5% vs 85.5%) on admission. Notably, the day 28-censored mortality was significantly lower after protocol implementation (40.3% vs 13.9%). By analyzing the 28-day mortality with univariate and multivariate model, initial presentation with neutropenia was identified as a risk factor [hazard ratio (HR) = 8.45, 95% confidence interval (CI) = 1.76-40.6], while protocol implementation (HR = 0.27, 95% CI = 0.11-0.71) was a protective factor. Conclusions A multidisciplinary bundle care protocol for NF including board-spectrum empirical antibiotic regimen and inter-professional collaboration was feasible, which was associated with improved overall and 28-day survival.

Creating an Innovative Business Model for the Performance of Commercial Dental Clinics

Providing dental care to the population is associated with the active introduction of new technologies, personnel management methods, and business processes. In this sense, dentistry is at the forefront of the development of medicine and other economic sectors. However, the active practical implementation of advanced technologies for the provision of dental services requires personnel to have increased motivation and highly qualified labor, to develop new protocols for patient management, and to use more advanced equipment and materials, while administrative and management personnel should introduce progressive methods of labor motivation and economic and mathematical models of material and moral stimulation. This research aims to create an innovative business model for the development of a commercial dental clinic (CDC) that provides paid dental services. Economic and mathematical modeling and nonlinear programming are aimed at maximizing dentists’ wages, together with financial incentives for the work of administrative and managerial personnel and deductions for the development of a typical commercial dental clinic in Moscow based on the actual volume of dental services and the costs of their provision. With the volume of paid dental services growing by one and a half times, the innovative business model makes it possible to increase clinic income by a factor of 1.66 and dentists’ salaries by a factor of 2.24, raise deductions for labor incentives for administrative and managerial personnel by a factor of 1.66, and increase total profit by a factor of 1.75. During the research, it was possible to ensure early repayment of a loan of 5 million rubles for clinic development in 21 months. Additional research is needed because of the possible variability of the dental market and lending conditions. Doi: 10.28991/HIJ-2024-05-01-05 Full Text: PDF