Bleeding Score Research Articles

Evaluating the impact of the self-BAT screening tool on patient outcomes: Results of the let's talk period project.

One of the many challenges in diagnosing bleeding disorders is distinguishing between normal and abnormal bleeding symptoms. Letstalkperiod.ca is an educational website that includes an online self-administered bleeding assessment tool (Self-BAT) which is a validated screening tool that enables patients to independently determine their bleeding scores (BS). The aim of this study was to evaluate patient outcomes for those referred with an abnormal Self-BAT BS compared to those referred without the prior use of the Self-BAT. This was a retrospective, observational study. After obtaining REB approval, chart review was performed for patients evaluated for a suspected bleeding disorder in a tertiary care centre between 2016 and 2023. 351 patients (310 female) were identified for inclusion with a mean age of 41 years. Of these patients, 30 were referred for a positive/abnormal Self-BAT BS and the remainder were referred for other reasons. Patients referred for a positive Self-BAT BS required interventions for their bleeding symptoms more often (73.3%vs. 36.7%, p≤.001). Though they were not diagnosed with an inherited bleeding disorder more often (6.7%vs. 10.7%, p=.754), patients referred for a positive self-BAT were more likely to be diagnosed with a bleeding disorder when the definition was expanded to include bleeding disorder of unknown cause (56.7%vs. 31.9%, p=.008). Results of this study suggest that the Self-BAT at letstalkperiod.ca can be a useful tool for patients and physicians to identify those needing referral to tertiary haematology clinics for evaluation and management of bleeding symptoms.

Prediction models for ischemic stroke and bleeding in dialysis patients: a systematic review and meta-analysis

Abstract Background Patients with kidney failure on maintenance dialysis have a high stroke and bleeding risk. Multivariable prediction models can be used to estimate the risk of ischemic stroke and bleeding. A systematic review and meta-analysis was performed to determine the performance of the existing models in patients on dialysis. Methods MEDLINE and Embase databases were searched, from inception through January 12, 2024, for studies of prediction models for stroke or bleeding, derived or validated in dialysis cohorts. Discrimination measures for models with c-statistic data from ≥ 3 cohorts were pooled by random effects meta-analysis and a 95% prediction interval (PI) was calculated. Risk of bias was assessed using PROBAST. The review was conducted according to the PRISMA statement and the CHARMS checklist. Results Eight studies were included in this systematic review. All the included studies validated pre-existing models that were derived in cohorts from the general population. None of the identified studies reported the development of a new dialysis specific prediction model for stroke, while dialysis specific risk scores for bleeding were proposed by two studies. In meta-analysis of c-statistics, the CHA2DS2-VASc, CHADS2, ATRIA, HEMORR(2)HAGES and HAS-BLED scores showed very poor discriminative ability in the dialysis population. Six of the eight included studies were at low or unclear risk of bias and certainty of evidence was moderate. Conclusions The existing prediction models for stroke and bleeding have very poor performance in the dialysis population. New dialysis-specific risk scores should be developed to guide clinical decision making in these patients.

Long-Term Clinical and Radiographic Outcomes of Hydrophilic Implants: A 10-Year Study in a Specialist Private Practice.

To report the 10-year clinical and radiographic outcomes of implants placed in grafted (GBR) and non-grafted (no-GBR) sites in a Swiss specialist private practice using hydrophilic implants with a low surface roughness flange. Fifty consecutively enrolled patients received 159 hydrophilic implants with a low surface roughness flange. A first re-evaluation was performed 1 year after delivery of restoration (T1). An additional examination was performed at the 10-year follow-up (T2) including the assessment of clinical (i.e., periodontal/peri-implant pockets probing depths (PPD) (mm), full-mouth bleeding score (%), implant survival rate, mid-buccal keratinized mucosa (KM) width in mm, and peri-implant phenotype), and radiographic (i.e., marginal bone level change [ΔMBL]) outcomes. Biological, mechanical and technical complications were also recorded. Out of the initial cohort, 22 patients (9/40.9% male and 13/59% female) and 63 implants (47 with GBR, 16 without GBR), could be re-examined at T2. Overall, ΔMBL (T2-T1) was -0.56 ± 0.96 mm. In the GBR group, ΔMBL were significantly higher at the distal sites compared to the no-GBR group (-0.75 ± 1.17 mm vs. -0.12 ± 1.29 mm, p = 0.045), however, in the GBR group MBL started at a higher level at T1 but were similar with the no-GBR group at T2. Implant survival was 100% with only very few technical complications (6.3%). Mean PPD amounted to 3.84 ± 1.00 mm with significantly higher values in the GBR group (3.98 ± 1.08 mm vs. 3.45 ± 0.60 mm; p = 0.016). Nineteen implants (30.1%) were diagnosed with peri-implant health while 44 (69.9%) presented with peri-implant mucositis. Within the limitations of this study, favorable clinical and radiographic conditions were recorded around hydrophilic implants with a low surface roughness flange placed in pristine and augmented bone after 10 years in function.

Periodontal and peri-implant bleeding on probing in patients undergoing supportive maintenance: a cross-sectional study

ObjectiveAssessment of periodontal and peri-implant inflammation, evidenced by bleeding on probing (BOP), among partially dentate patients receiving supportive periodontal care (SPC).Material & methodsPatient charts from the Center for Dentistry and Oral Medicine of Goethe-University Frankfurt with at least one dental implant were reviewed. Measurements included probing pocket depth (PPD), BOP, and full-mouth bleeding and plaque scores for all teeth and implants.Results100 patients (median; lower/upper quartile: age 68.9; 62.6/76.5 years; 51 females, 6 smokers, 16 with anticoagulative medication, 6 localized stage III, 57 generalized stage III, 37 stage IV, 70 grade B, 30 Grade C, 22; 20/25 teeth left, 2; 1/4 implants) were examined. Peri-implant BOP (24; 11.5/41.5%) was significantly higher than BOP at teeth (14; 8/21.5%) (p < 0.001). A median of 0 (0/1) implants exhibited no BOP and 0 (0/1) only one site with BOP. Shallow pockets (PPD 1–3 mm) were significantly more frequent in teeth (93; 87/97%) than in implants (72.5; 58/94.5%; p < 0.001). Moderately deep pockets (PPD 4 and 5 mm) were less frequent in teeth compared to implants (6; 2/11%; 22; 5.5/33%; p < 0.001).ConclusionsPeri-implant sites exhibit a higher prevalence of BOP compared to periodontal sites in SPC patients.Clinical relevancePractitioners providing supportive periodontal care to patients with dental implants should anticipate a greater prevalence of BOP around implants compared to teeth.

Management of intracavitary bleeding during ultra-early minimally invasive intracerebral hemorrhage evacuation.

Surgical evacuation of intracerebral hemorrhage (ICH) at early time points contributes to improved functional outcomes. However, ultra-early evacuation has been associated with postoperative rebleeding, a devastating complication that contributes to worse outcomes. Minimally invasive endoscopic techniques allow for intraoperative management of active bleeding, potentially allowing for safe and effective hemostasis at ultra-early time points. The authors proposed and prospectively assigned an intraoperative grading scale that quantified the severity of bleeding encountered intraoperatively. They hypothesized that ultra-early evacuation would correlate to increased intraoperative bleeding but not postoperative rebleeding or worse long-term clinical outcomes in a cohort of patients undergoing minimally invasive endoscopic evacuation. Patients presenting to a large healthcare system with spontaneous supratentorial ICH were triaged to a central hospital for potential surgical evacuation. Inclusion criteria for evacuation included age ≥ 18 years, premorbid mRS score ≤ 3, hematoma volume ≥ 15 mL, and presenting National Institutes of Health Stroke Scale score ≥ 6. A 5-point scale was developed and prospectively applied to grade the severity of bleeding encountered intraoperatively. A score of 1 indicated no active intraoperative bleeding. A score of 2 indicated minimal bleeding treated with irrigation alone. A score of 3 indicated bleeding that required cauterization to control. A score of 4 indicated bleeding that required irrigation or cauterization for at least 15 minutes to achieve hemostasis. A score of 5 indicated bleeding that required irrigation or cauterization for at least 1 hour. The authors evaluated 142 consecutive patients. The median bleeding score was 2 (IQR 2-4). Greater preoperative volume, concomitant intraventricular hemorrhage, and earlier time to evacuation were independently associated with increased bleeding score. Specifically, ultra-early evacuation within 5 hours was independently associated with a 2.4-point greater bleeding score as compared with evacuation thereafter (β = 2.41, 95% CI 1.44-3.38; p < 0.0001). Despite having higher intraoperative bleeding scores, patients undergoing ultra-early evacuation did not have an increased likelihood of postoperative rebleeding (14% vs 3%, p = 0.23), 30-day mortality (0% vs 6%, p = 0.99), or worse median 6-month mRS scores (4 [IQR 2-5] vs 4 [IQR 3-5], p = 0.51). Ultra-early evacuation within 5 hours of ictus is associated with increased intraoperative bleeding but not postoperative rebleeding or worse clinical outcomes. These findings suggest that the benefits of ultra-early evacuation can be explored without an increased risk of postoperative rebleeding when utilizing a minimally invasive endoscopic technique with good intraoperative visualization, active irrigation for targeted tamponade, and direct cauterization of bleeding vessels.

A comparative study of two different doses of dexmedetomedine as an adjuvant to lignocaine in infiltration block for tympanoplasty: a triple-blinded, prospective, randomized controlled trial.

The ideal anesthetic drug choice for local infiltration anesthesia under monitored anesthesia care must provide analgesia and patients' comfort along with a bloodless surgical field for patients. We hypothesized that dexemedetomidine can provide better visibility of the surgical field at a higher dose of 1 µg/kg than 0.5 µg/kg, along with providing sedation and analgesia. After institutional ethics committee clearance and written informed consent, this prospective, randomized, triple blind study was conducted on ninety patients, between 18- 65 years who were scheduled for tympanoplasty. The patients were randomly assigned to either the dexmedetomidine (DEX) 0.5 group or the DEX 1.0 group, and received 10 ml solution containing 2% lignocaine with 0.5 µg/kg dexmedetomidine, or the 1 µg/kg dexmedetomidine. The operative surgeon performed local infiltration using standardized 5-point infiltration technique around the auricle. The primary objective was to compare the intraoperative bleeding at the surgical site. The comparison of normally distributed variables was conducted using the Student's t-test, whereas non-normally distributed variables was compared using the Mann-Whitney U test. The analysis of qualitative data was conducted using the chisquare/Fisher's exact test. A P value less than 0.05 was considered statistically significant. The overall bleeding score was significantly higher in the DEX 0.5 group (3.21 ± 0.727) than the DEX 1.0 group (1.43 ± 0.661) (P value < 0.001). The time to first analgesic requirement and surgeon satisfaction score were also significantly higher in the DEX 1.0 group. Combining dexmedetomidine at a dose of 1 µg/kg with 2% lignocaine for infiltration provided improved analgesia and improved the surgical field during tympanoplasty performed under monitored anesthesia care.

Outcomes of Nonsurgical Periodontal Therapy in Gingivitis and Periodontitis Patients Treated by Senior Dental Students.

This retrospective study aimed to evaluate the outcomes of nonsurgical periodontal therapy performed by senior dental students. Electronic records of patients treated by senior dental students at the comprehensive care clinic in King Abdulaziz University Dental Hospital were reviewed retrospectively. Patients diagnosed with gingivitis or periodontitis who had undergone at least one session of scaling and root planing were included in this study. The following periodontal parameters were assessed: BOP, PI, PD and number of residual pockets. A total of 618 patients were included in this study (60.2% females and 39.8% males). BOP reduced from a median of 40% (IQR: 26.0%-62.0%) at baseline to 13% (IQR: 9.0%-20.3%) at re-evaluation in the gingivitis group (p < 0.0005). Similarly, a significant reduction in BOP, from 45% (IQR: 28.0%-64.3%) at baseline to 14% (IQR: 9.0%-21.5%) after phase I therapy, was observed in the periodontitis group (p > 0.001). In both groups, 31%-32% of patients had BOP < 10 at re-evaluation. PD of ≥ 5 mm was observed in 50.8% of patients with periodontitis at baseline; however, 38% of these patients had no residual pockets at re-evaluation. NSPT performed by senior dental students was effective in improving the periodontal status of the patients. Both gingivitis and periodontitis patients showed significant improvement in BOP and PI. Approximately, 32% of patients showed a reduction in BOP suggestive of a bleeding score associated with periodontal health. Moreover, patients diagnosed with periodontitis exhibited a significant reduction in the number of sites with deep probing (≥ 5).

Prolonged dual antiplatelet therapy in an extended Phase 3 Cardiac Rehabilitation Program following myocardial infarction

Abstract Background Prolonged dual antiplatelet therapy (P-DAPT) is recommended in selected patients beyond 12 months after myocardial infarction (MI). Several risk scores have been developed to estimate the ischemic and bleeding risk and individualize the decision-making process. Purpose We aim to analyse the factors, including ischemic and bleeding scores, associated with P-DAPT prescription in MI patients submitted to a Cardiac Rehabilitation Program (CRP). Methods Patients with ST-segment elevation MI (STEMI) or occlusion MI (OMI) who were submitted to our CRP underwent Phase 2 CRP and were prospectively included. Patients were followed in an extended Phase 3 CRP, and a follow-up visit was scheduled 12 months after hospital discharge. Baseline and follow-up clinical characteristics and treatment after the 12-months visit were registered, specifically P-DAPT. Ischemic (DAPT score) and bleeding (PRECISE-DAPT and CRUSADE scores) risk scores were retrospectively computed. Predictors of P-DAPT were studied by univariate analysis and multivariable binary logistic regression. The model was tested by area under the curve (AUC) analysis in receiver operating characteristic curves. A p&amp;lt;0.05 was considered statistically significant. Results The cohort comprised 78 patients (mean age 61±11 years, 84.6% male). Anterior and inferior STEMI were the most common presentations (43.6% and 47.4%, respectively). The most prevalent cardiovascular risks factors were hypercholesterolemia (85.9%), hypertension (53.8%), smoking habit (46.2%) and diabetes mellitus (23.1%). P-DAPT was prescribed in 39 (50%) patients beyond 12 months after MI, primarily combining aspirin 100mg o.d. and ticagrelor 60mg b.i.d. (n=33, 84.6%). On multivariate analysis, variables associated with P-DAPT prescription were hypertension (HR 4.92 [1.37-17.68], p=0.02), diabetes mellitus (HR 5.13 [1.09-24.09], p=0.04), multivessel disease (HR 5.54 [1.55-19.79], p=0.008), and stent diameter &amp;lt;3mm (HR 5.46 [1.25-23.78], p=0.02). The predictive power of the model was excellent (AUC 0.88 [0.8-0.96], p&amp;lt;0.001). Ischemic (DAPT score) and bleeding (PRECISE-DAPT and CRUSADE) risk scores were not associated with P-DAPT neither in continuous form nor by using their standard cutoffs (≥2, &amp;lt;25 and &amp;gt;40 points, respectively). Conclusions In a real-life cohort of MI patients undergoing extended Phase 3 Cardiac Rehabilitation, P-DAPT was prescribed in half of the population. Clinical (hypertension and diabetes mellitus) and angiographic (multivessel disease and stent diameter &amp;lt;3mm) variables straightforwardly predict the likelihood of receiving P-DAPT, unlike ischemic and bleeding risk scores. The clinical consequences of this management should be further explored.Prolonged DAPT in Cardiac Rehabilitation

Evaluation of the biomarker-based ABC-AF-bleeding risk score and clinically based bleeding scores in 31,605 patients with atrial fibrillation treated with oral anticoagulation

Abstract Background International guidelines recommend a systematic evaluation of bleeding risk in patients with atrial fibrillation (AF) to guide oral anticoagulation. However, it remains challenging to accurately predict bleeding risk. The biomarker-based ABC-AF-bleeding risk score to predict bleeding in anticoagulated patients with AF has shown promise. Purpose To evaluate the performance of the biomarker-based ABC-AF-bleeding risk score and compare its performance with other bleeding risk scores in 31,605 patients randomized to direct oral anticoagulant or warfarin using individual patient data from three randomized clinical trials. Methods The COMBINE AF biomarker data set contains individual patient data from three pivotal randomized trials (ARISTOTLE, ENGAGE AF-TIMI 48, and RE-LY) comparing apixaban, edoxaban or dabigatran with warfarin, in patients with AF at increased risk of stroke. The ABC-AF-bleeding biomarkers were analyzed in plasma samples collected at baseline (hemoglobin, troponin T high-sensitivity, and GDF-15) using Roche Diagnostics Elecsys assays. The biomarker-based ABC-AF-bleeding risk score (Age, Biomarkers, Clinical history of prior bleeding) was calculated as previously published. The discrimination was assessed by Harrell’s c index and compared with three clinically based bleeding risk scores; HASBLED, ORBIT, and DOAC. Results During a median follow-up time of 2.0 years, a total of 1,572 ISTH major bleeding events occurred (incidence rate per 100 person-years of 2.79) including 593 gastrointestinal (1.04) and 270 intracranial (0.47) bleeding events. The biomarker-based ABC-AF-bleeding score was well calibrated for major bleeding in the total material (Figure). The c indices for major bleeding were 0.68 (95% confidence interval 0.67-0.70), for gastrointestinal bleeding 0.70 (0.68-0.72), and for intracranial bleeding 0.66 (0.63-0.69). The biomarker-based ABC-AF-bleeding risk score provided superior discrimination compared with the clinically based risk scores in the full cohort (Table). The ABC-AF-bleeding risk score also provided superior discrimination for major bleeding in clinically relevant subgroups based on age, sex, body mass index, coronary artery disease, diabetes, heart failure, kidney function, and irrespective of DOAC or VKA use. Conclusions In patients with AF treated with different types of OAC the biomarker-based ABC-AF-bleeding score provide better discrimination of the risk för major bleeding than risk scores based only on clinical factors. The results were consistent for different types of bleeding and across multiple subgroups. There was good calibration when comparing predicted vs observed rate of major bleeding. These findings support the utility of the biomarker-based ABC-AF-bleeding risk score for advancing precision medicine in patients with AF.Calibration of ABC-AF-bleeding scoreTable

Three-Year Efficacy and Safety of Mirikizumab Following 152 Weeks of Continuous Treatment for Ulcerative Colitis: Results From the LUCENT-3 Open-Label Extension Study.

Mirikizumab, a p19-directed interleukin-23 monoclonal antibody, has demonstrated induction of clinical remission at week 12 with maintenance through week 104 in patients with moderately-to-severely active ulcerative colitis (UC). Results are presented from the LUCENT-3 open-label extension study through week 152. Of 868 LUCENT clinical trial program mirikizumab-treated induction patients, 544 were responders of whom 365 were rerandomized to mirikizumab maintenance. Of these, 324 completed week 52 and 316 entered extension treatment (286 week 52 responders; 179 week 52 remitters). Efficacy and safety outcomes are reported for mirikizumab-treated LUCENT-3 participants, including biologic-failed patients, with data for week 52 maintenance responders/remitters. Discontinuations or missing data were handled by nonresponder imputation, modified nonresponder imputation (mNRI), and observed cases. Using mNRI, 81.6% of week 52 responders demonstrated clinical response at week 152. Week 152 remission rates for week 52 responders included clinical (56.1%), corticosteroid-free (CSF; 54.5%), endoscopic (61.0%), histologic-endoscopic mucosal remission (HEMR; 52.6%), symptomatic (74.9%), and bowel urgency (BU; 58.6%). At week 152, 53.3% of week 52 responders achieved histologic-endoscopic mucosal improvement (HEMI) and 74.3% achieved BU clinically meaningful improvement (CMI). Among week 52 remitters, 85.4% showed a clinical response at week 152, with clinical (70.1%), CSF (68.9%), endoscopic (72.0%), HEMR (63.4%), symptomatic (81.4%), and BU (60.8%) remission. At week 152, among week 52 remitters, 64.0% of patients achieved HEMI and 75.6% achieved BU CMI. Stool frequency, rectal bleeding, BU, and abdominal pain score reductions from induction baseline to maintenance week 52 were sustained through week 152 for week 52 completers. Overall, in the safety population, 7.4% of patients reported severe adverse events (AEs); 5.3% discontinued treatment due to AEs. AEs of special interest included opportunistic infection (1.8%), hepatic disorders (3.2%), cerebrocardiovascular events (1.5%), and malignancy (0.3%). Patients with antidrug antibodies reduced over time from 23.6% in year 1 to 3.2% in year 3. Symptomatic, clinical, endoscopic, histologic, and quality-of-life outcomes support long-term sustained benefit of mirikizumab treatment up to 152 weeks in patients with UC, including biologic-failed patients, with no new safety concerns. ClinicalTrials.gov: NCT03518086; NCT03524092; NCT03519945.

Patients treated with vitamin K oral anticoagulants in family practice: a new approach to bleeding risk assessment. An ancillary study by the CACAO prospective general practice cohort.

The ability of bleeding risk scores to predict major bleeding (MB) or clinically relevant nonmajor bleeding (CRNMB) remains a topic of contention, particularly in nonselected patients in family practice. In addition, the capacity to predict bleeding risk using simple variables has yet to be established. The main objective was to confirm that severe anemia was the most predictive factor for the estimation of bleeding risk in patients treated with vitamin K antagonists (VKAs). Secondary objectives were to test the capacity of different bleeding scores to detect high-risk patients. Subsequently, the impact of functional decline on bleeding incidence was explored. The CACAO study was a multicenter prospective cohort study of patients who, due to nonvalvular atrial fibrillation (NVAF) and/or venous thromboembolism (VTE), had been prescribed an oral anticoagulant by their general practitioner (GP) as a prophylactic measure. Patient characteristics were collected at the time of inclusion by GPs, who then monitored them in accordance with standard practice for one year. MB and CRNMB were the main outcomes for one year. By applying this approach, a total of 13 scores were analyzed. Aaemia was found to be strongly associated with MB (HR: 2.77, 95% CI: 1.2-6.36), with a particularly pronounced association observed in cases of severe anemia (HR: 12.9, 95% CI: 2.76-60.35). Twelve out of 27 MB cases were not identified by at least half of the scores. By contrast, functional decline was identified as a novel factor associated with MB (HR: 2.45, 95% CI: 1.13-5.31). Preexisting anemia is a major prognostic factor associated with the occurrence of bleeding. It seems relevant to suggest that functional decline should be considered by GPs when assessing bleeding risk.

Clinical trial comparing the use of Orcellex® Brush versus Cervex-Brush® on vaginal vault smear cytology adequacy rate in patients treated with radiotherapy for cervical cancer.

This study aims to evaluate and compare the Cervex-Brush® and Orcellex® Brush as sampling devices for vaginal vault smear cytology in cervical cancer patients treated primarily with radiotherapy. A randomized crossover trial was conducted at a gynecological oncology center in Hong Kong to compare the Cervex-Brush® and Orcellex® Brush in terms of their vault smear adequacy rate in cervical cancer patients who underwent radiotherapy. One hundred sixty cervical cancer patients treated with primary radiotherapy and undergoing follow-up surveillance by vaginal vault cytology were recruited. The smear adequacy rate was 90.6% for Cervex-Brush® and 91.9% for Orcellex® Brush. The rates of low cellularity for both brushes were similar (76.8% for Cervex-Brush® vs. 76.1% for Orcellex® Brush). The detection rates of abnormal smears were also not significantly different (2.8% for Cervex-Brush® vs. 4.2% for Orcellex® Brush). The 2 brushes were also not significantly different in terms of pain score and degree of bleeding. It was further observed that the second smear collection was more painful and patients who were on hormonal replacement therapy demonstrated less bleeding. There was no difference between the Orcellex® brush and the Cervex-Brush® in terms of smear adequacy rate, rate of high cellularity and the detection of abnormal smears. There was also no significant difference between the 2 brushes in terms of pain and the degree of bleeding. Therefore, the Orcellex® Brush can be considered a suitable alternative sampling device for vault smear collection in patients who have undergone radiotherapy for cervical cancer. ClinicalTrials.gov Identifier: NCT04461574.

Optimizing Beneficial Oral Hygiene Care: Transitioning from Manual Brushing and Utilizing Powered Toothbrushes to Improve Plaque Control and Prevent Gingival Inflammation

Objective: The main purpose of this research is to compare the effectiveness of powered and manual toothbrushes in controlling plaque and gingival inflammation. Background: Dental health and maintaining effective oral hygiene practices are crucial. The advantages and disadvantages of using manual or powered toothbrushes in removing gingivitis and plaque are discussed. Methodology: The paper provides an in-depth literature analysis and review of previous articles that investigated the effectiveness of manual and powered toothbrushes. Terms like gingivitis, host factors, manual dexterity, effectiveness of toothbrush types, and safety were analyzed from 2000 to 2024. Results: The research concludes that powered toothbrushes achieve a moderate reduction in plaque and gingival bleeding scores compared to manual toothbrushes, which require more brushing force. Individuals needed to maintain regular oral routines and brush for at least two minutes to achieve desired results. Conclusion: Both toothbrush types are vital for dental health. Powered brushes are considered safe and more effective in plaque and gingivitis removal, especially for individuals with dexterity issues. However, manual brushes remain a choice for many people globally. A person's preference plays a role in choosing between the two types. Update Dent. Coll. j: 2024; 14(2): 38-44

Patient-reported data on the severity of Von Willebrand disease.

The severity of Von Willebrand disease (VWD) is currently based on laboratory phenotype. However, little is known about the severity of the patient's experience with the disease. The most recent VWD guidelines highlight the need for patient-reported outcomes (PROs) in VWD. The study aimed to investigate the patient-perspective on VWD severity and to identify key factors that determine the severity of disease experienced by patients. Patients participated in a nationwide cross-sectional study on VWD in the Netherlands (WiN-study). Patients filled in a questionnaire containing questions on the experienced severity of VWD (4-point scale), bleeding score (BS) and quality of life (QoL). We included 736 patients, median age of 41.0 years (IQR 23.0-55.0) and 59.5% were women. A total of 443 had type 1, 269 type 2 and 24 type 3 VWD. Self-reported severity of VWD was categorized as severe (n=52), moderate (n=171), mild (n=393) or negligible (n=120). Classification by historically lowest FVIII:C levels<0.20 IU/mL as a proxy for severe VWD aligned with patient-reported severity classification with a 72% accuracy. Type 3 VWD (OR=4.02, 95%CI: 1.72-9.45), higher BS (OR=1.09, 95%CI: 1.06-1.11), female sex (OR=1.36, 95%CI: 1.01-1.83), haemostatic treatment in the year preceding study inclusion (OR=1.53, 95%CI: 1.10-2.13) and historically lowest VWF:Act levels (OR=0.26, 95%CI: 0.07-1.00) were independent determinants of patient-reported severity. This study shows that patient-reported data provide novel insights into the determinants of experienced disease severity. Our findings highlight the need for studies on PROs with validated questionnaires to assess the burden of VWD.

Non-Surgical Treatment of Moderate Periodontal Intrabony Defects With Adjunctive Cross-Linked Hyaluronic Acid: ASingle-Blinded Randomized Controlled Clinical Trial.

To evaluate the clinical outcomes of moderate intrabony defects treated with minimally invasive non-surgical technique (MINST) with or without adjunctive delivery of cross-linked hyaluronic acid (xHyA) gel. Forty-two patients with 42 interdental intrabony defects were randomly assigned to test (MINST + xHyA) or control procedures (MINST alone). Probing depth (PD), clinical attachment level (CAL), gingival recession (GR) and bleeding on probing (BOP) at the treated sites were assessed at baseline and at 3 and 6 months. Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS) were recorded at baseline and after 6 months. Radiographic evaluation was performed at baseline and after 6 months, assessing the defect fill (DF) and radiographic defect angle (RDA). The primary outcome variable was PD change. Thirty-eight patients completed the trial without any adverse events. At 6 months, a statistically significant improvement (p < 0.05) was measured in all clinical parameters except GR (p > 0.05). However, no statistically significant differences were found between the experimental and control procedures (p > 0.05). Statistically significant differences between the test and control sites were observed at 3 months for PD and CAL changes (p < 0.05). The DF change was statistically significant when comparing experimental and control procedures at 6 months (p < 0.05). Both procedures failed to show statistically significant differences in terms of RDA changes at 6 months (p > 0.05). Within their limitations, the present results indicate that (a) treatment of intrabony defects with MINST, with or without application of xHyA gel, resulted in statistically significant improvements in the investigated clinical parameters at 3 and 6 months after therapy, and (b) although the adjunctive use of xHyA gel to MINST improved the clinical outcomes compared with MINST alone up to 3 months, statistically significant differences were not observed at 6 months. The study protocol was registered in ClinicalTrial.gov (NCT05188898).

Application and clinical effects in lung bullae resection of CT 3-dimensional reconstruction.

To investigate the value and clinical effect of computed tomography (CT) 3-dimensional reconstruction technology in lung bullae resection. Ninety-eight patients who underwent thoracoscopic surgical resection of lung bullae in our hospital from February 2019 to February 2023 were selected and divided into 2 groups according to the principle of voluntary participation in the clinical trial, of which 43 cases underwent preoperative spiral CT for thin-layer enhancement or planar CT scanning of lung bullae (control group), and 43 cases were imaged with MimicsMedical 21 software for 3-dimensional reconstruction to develop a surgical plan (observation group). To compare the surgery-related indexes, postoperative complications, pain, and analgesic use between the 2 groups, we measured serum creatine phosphokinase and myoglobin levels. The amount of surgical bleeding, drainage volume, hospital stay, and postoperative visual analog scale score of the research group were lower than those of the control group (P < .05), and the duration of analgesic medication was shorter than that of the control group (P < .05), and the levels of serum creatine phosphokinase and myoglobin were lower than those of the control group at 1 and 3 days postoperatively, and the differences were statistically significant (P < .05). Preoperative CT 3-dimensional reconstruction technique can clearly show the anatomical structures around the lung bullae and has its application value for precise lung bullae.

When is the use of intravenous immunoglobulin appropriate in immune thrombocytopaenia?

Intravenous immunoglobulin (IVIg) is the gold standard treatment for severe cases of immune thrombocytopaenia (ITP). However, its cost, limited duration of efficacy and market supply tension have led French guidelines to reserve IVIg for ITP patients with formal contra-indications to corticosteroids, with French bleeding score ('Khellaf score') > 8, and corticosteroid-resistant patients either with Khellaf score ≤ 8 or in preparation for an invasive procedure or during pregnancy. We studied the prescribing practices of IVIg for ITP in real-life conditions and assessed their compliance with French guidelines. A monocentric retrospective study was conducted between 2016 and 2020 among 114 patients hospitalized in our unit, for a total of 208 IVIg treatments. In 37% of cases, the Khellaf score was >8, validating IVIg prescription according to French guidelines. In the remaining cases, reasons noted for use of IVIg included corticosteroid resistance (33.7%), preparation for an invasive procedure (8.5%), context of pregnancy (6.6%) and contra-indication to corticosteroids (3.3%). After analysis, IVIg prescription was considered valid according to current French guidelines in 84.4% of cases. Non-compliant IVIg prescription was more frequent in younger patients (p = 0.027). Concomitant anti-coagulation was also noted as an argument for IVIg prescription outside of the current French guidelines.

Can systemic antibiotics reduce the need for surgical intervention in treating peri-implantitis?

A retrospective cohort design was used to assess the long-term clinical effectiveness of systemic amoxicillin and metronidazole, used adjunctively with non-surgical peri-implantitis treatment (NST) and whether it prevents the need for further surgical interventions. Of the 57 peri-implantitis patients examined, 45 patients were included in this study. The participants were divided into two subgroups in accordance to who had received NST with or without systemic antibiotics. Selection was based on prior participation in a three-month randomised control trial, ensuring comparability of data regarding peri-implantitis severity and treatment history. Data were extracted pre-treatment, 3-months post-treatment and at a long-term follow-up interval of 36 months. The primary outcome was the need for additional surgical intervention and was analysed via Kaplan-Meier analysis and Cox regression. A multitude of secondary clinical outcomes were evaluated using parametric and non-parametric tests, including peri- implant probing depth, bleeding scores and treatment success. Overall, 62.2% of the 45 NST patients did not need surgical peri-implantitis treatment: 73.9% of the subgroup with antibiotics and 50% of the subgroup without antibiotics respectively. However, the difference between the two groups was not statistically significant (log-rank test, p = 0.110). The Cox regression analysis also displayed no significance over the first three years post-treatment (p = 0.115). Additionally, the study found that deeper peri- implant pockets at baseline significantly predicted the need for future surgical treatment (p = 0.031), highlighting the importance of initial disease severity in treatment outcomes. The study concludes that the adjunctive use of systemic amoxicillin and metronidazole with NST may delay but not statistically reduce or prevent a future surgical need. Although a short-term reduction in clinical inflammatory parameters was evident, the long-term effectiveness in altering the progression of peri-implantitis remains limited.

Comparison of the efficacy of tibial transverse transfer and periosteal distraction techniques in the treatment of diabetic foot refractory ulcers.

To investigate the efficacy of comparing tibia transverse transport (TTT) and periosteal distraction in treating diabetic foot ulcers. A retrospective analysis of 19 patients with diabetic foot ulcers treated with both procedures between February 2020 and November 2022, 8 of whom were treated with the tibial transverse transfer technique (transfer group) and 11 with the osteochondral distraction technique (distraction group), was performed to compare and analyze the clinical efficacy of the two methods. All wounds were healed in both groups, and the healing time ranged from 15 to 41days with a mean of 28d. The limb preservation rate was 100%. The operative time, intraoperative bleeding, and pain score in the operative area were significantly less in the distraction group than in the removal group, with statistically significant differences (P < 0.05). Intra-group comparison between the two groups of patients after surgery revealed that the skin temperature, ABI, TcPO2, SWM and VAS of the affected limb were significantly improved compared with those before surgery, and the difference was statistically significant (P < 0.05). The expression levels of VEGF, bFGF, EGF and PDGF were significantly higher than before surgery in both groups, and the difference was statistically significant (P < 0.05). No statistically significant differences were found in skin temperature, ABI, TcPO2, SWM, VAS, VEGF, bFGF, EGF and PDGF between the two groups at the corresponding time points preoperatively and postoperatively (P > 0.05). The Periosteal distraction technique can significantly promote the healing of diabetic foot ulcers. It has the same efficacy as TTT in promoting the healing of diabetic foot ulcer wounds and improving the peripheral circulation of affected limbs. In addition, the periosteal distraction technique has the advantages of small trauma, simple operation, few complications, and convenient nursing care.

One-month DAPT after biodegradable-polymer everolimus-eluting stent implantation in women at high-bleeding risk: Insights from the POEM trial.

We conducted a prespecified subanalysis of the POEM trial to assess the association between sex and clinical outcomes following a short 1-month dual-antiplatelet-therapy (DAPT) period after percutaneous coronary intervention (PCI) with bioresorbable polymer everolimus-eluting stent (BP-EES) among patients at high bleeding risk (HBR). Shortening the DAPT period after PCI is an effective bleeding avoidance strategy with contemporary drug-eluting stents. Whether sex affects the risk of adverse events following PCI is still debated. Patients at HBR undergoing PCI with BP-EES were enrolled and treated with 1-month DAPT. If anticoagulation was needed, study participants received an oral anticoagulant (OAC) in addition to a P2Y12 inhibitor for 1 month, followed by OAC only thereafter. The primary endpoint was a composite of cardiac death, myocardial infarction, or definite/probable stent thrombosis at 12 months. We report sex-based outcomes of patients included in the POEM study. We enrolled 129 (29.1%) women and 314 (70.9%) men. Women were older, with lower hemoglobin levels, and worse renal function. Accordingly, they had a trend for a greater number of HBR criteria fulfilled and a higher PARIS bleeding score. However, they were not at a significantly higher risk for the primary endpoint (men vs. women: 5.17% vs. 3.94%; HR 1.30; 95% CI: 0.48-3.54, p = 0.61), or any of the hemorrhagic and ischemic secondary endpoints. This prespecified subanalysis of the POEM trial suggests that 1-month DAPT following PCI with BP-EES may be a safe and effective therapeutic strategy for women at HBR.