A comparative evaluation of dental caries status and salivary properties of children aged 5-14 years undergoing treatment for acute lymphoblastic leukemia, type I diabetes mellitus, and asthma - In vivo.
J Indian Soc Pedod Prev Dent. 2018 Jul-Sep;36(3):283-289
Authors: Dubey S, Saha S, Tripathi AM, Bhattacharya P, Dhinsa K, Arora D
Background: The subjective sensation of dry mouth, xerostomia, is a well-recognized problem in adults, however, relatively little attention has been paid to this issue in children. Xerostomia commonly occurs as an adverse effect of drugs in asthma and leukemia, which alter the composition and flow of saliva and systemic diseases, including diabetes. It decreases the oral pH and significantly increases the development of plaque and dental caries.
Aim: This study aims to evaluate and compare the dental caries status and salivary properties of children aged 5-14 years undergoing treatment for acute lymphoblastic leukemia, type 1 diabetes mellitus, and asthma - in vivo.
Materials and Methods: The study was divided into two parts: Part I: Oral examination was performed and dental caries status Decayed, Missing, Filled Teeth/ decayed, extraction, filled teeth (DMFT/deft) was noted and Part II: Salivary analysis was performed by GC Saliva-Check BUFFER kit to check for hydration, viscosity, pH of saliva, salivary flow, and buffering capacity.
Statistical Analysis: All statistical analysis was performed using the SPSS 21 statistical software version. Inferential statistics were performed using Chi-square test and ANOVA. Post hoc pairwise comparison was done using Post hoc Tukey's test.
Results: The prevalence of mean DMFT/deft with regard to salivary properties was highest in leukemic patients followed in descending order by diabetic and asthmatic patients.
Conclusions: Leukemic patients had significantly higher caries and decreased salivary properties while asthmatic patients showed the least caries prevalence and best salivary properties.
PMID: 30246751 [PubMed - in process]
[Bronchial thermoplasty for asthma treatment].
Tuberk Toraks. 2018 Jun;66(2):156-165
Authors: Çalışkan T, Okutan O, Kartaloğlu Z
New asthma therapies such as omalizumab, mepolizumab and reslizumab are used according to the inflammatory phenotype, but there are many patients with asthma which are not suitable for these therapies or do not improve with these therapies. Bronchial thermoplasty (BT) was approved by FDA for the treatmet of adults with severe asthma and uncontrolled symptoms despite treatment with inhaler corticosteroids (ICS) and long-acting bronchodilators in 2010. BT is a minimally invasive bronhoscopic intervention based on radiofrequency energy delivery to the larger airways to reduce excessive airway smooth muscle mass. BT has been shown to be effective at reducing asthma exacerbations and improving asthma control for patients with severe asthma. BT is safe for 5 years after BT in patients with severe refractory asthma. BT may be primarily preferred for patients with nonallergic, non-eosinophilic (non-TH2) severe asthma not improving with standart treatments. Unfortunately, the mechanism of action of BT is incompletely understood. Uncertainty remains how to identify patients who will responde to this intervention. Several studies are underway that may show the place of BT in severe asthma and identify responders. There is also a need for studies comparing BT with other treatment options. This review will provide an overwiew of BT. We will discuss the latest evidence on the use of BT in asthma, patient selection criteria and performing the procedure will be reviewed.
PMID: 30246660 [PubMed - in process]
Effects of Exposure to New Car Interiors in Patients With Asthma and Allergic Rhinitis.
Allergy Rhinol (Providence). 2018 Jan-Dec;9:2152656718800060
Authors: Pepper AN, Bulkhi A, Smith CR, Colli M, Bergmann KC, Zuberbier T, Casale TB
Rationale: Vehicle interiors are an important microenvironment for atopic subjects. This study evaluated the subjective and objective physiologic and clinical effects of exposing subjects with asthma and allergic rhinitis to new 2017 Mercedes vehicles during 90-minute rides.
Methods: Ten adult asthmatics with allergic rhinitis were assessed before and 45 and 90 minutes into rides in a 2017 Mercedes-Benz S-Class sedan and GLE-Class SUV on 2 separate days. Assessments included spirometry, fractional exhaled nitric oxide, peak nasal inspiratory flow, asthma symptom scores, and physical examinations.
Results: Of the 10 subjects, 6 were women, mean age was 32 years, and 6 and 4 were using chronic asthma controllers or intranasal corticosteroids, respectively. None of the subjects had worsening of asthma or rhinitis symptoms during the rides. There were no statistically significant changes from baseline in forced expiratory volume in 1 second, forced expiratory volume in 1 second:forced vital capacity ratio, forced expiratory flow at 25%-75% of vital capacity, fractional exhaled nitric oxide, or peak nasal inspiratory flow at 45 or 90 minutes into the rides with either Mercedes vehicle (all P values > .1 using generalized linear mixed model).
Conclusion: The interior environment of the tested Mercedes vehicles did not cause changes in subjective or objective measures of asthma and allergic rhinitis. We suggest that this model system can be used to test other vehicles for putatively adverse effects on patients with allergic respiratory disorders.
PMID: 30245910 [PubMed]
Do guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review.
Chronic Illn. 2018 Sep 23;:1742395318799844
Authors: Saxby N, Beggs S, Kariyawasam N, Battersby M, Lawn S
Objectives To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. Methods Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE 'Guideline Quality Checklist', and mapping of the supporting evidence. Results Fifteen guidelines were identified: asthma ( n=7) and type 1 diabetes mellitus ( n=7), CF ( n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration ( n=15), chronic condition self-management education ( n= 17), clinicians' skills ( n= 4); personalized action plans ( n=3), problem-solving ( n=2); and the assessment of children's chronic condition self-management needs ( n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool ( n=2), and adolescence ( n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines' recommendations was poor; only 14 out of 57 journals listed as evidence were concordant. Discussion Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools.
PMID: 30244592 [PubMed - as supplied by publisher]
A rare presentation of pulmonary sarcoidosis as a solitary lung mass: a case report.
J Med Case Rep. 2018 Apr 13;12(1):94
Authors: Kelleher DW, Yaggi M, Homer R, Herzog EL, Ryu C
BACKGROUND: Sarcoidosis is a multisystem, chronic granulomatous disease of unknown etiology that predominantly affects the lungs. Pulmonary sarcoidosis classically presents with constitutional symptoms and computed tomographic scan findings of bilateral, symmetric micronodules in a peribronchovascular distribution with upper and middle lung zone predominance accompanied by bilateral, symmetric hilar lymphadenopathy. A solitary lung mass is a rare finding for pulmonary sarcoidosis, and with its associated constitutional symptoms, it strongly mimics a malignancy. We aimed to provide further insight into the broad differential diagnosis of a lung mass by describing our experiences in the care of a patient who presented with clinical and radiographic features of lung cancer who was ultimately found to have an atypical manifestation of stage II pulmonary sarcoidosis.
CASE PRESENTATION: A 44-year-old African American woman with a history of childhood asthma and type 2 diabetes mellitus presented with shortness of breath. After being treated for a presumed asthma exacerbation with prednisone, she experienced worsening dyspnea, night sweats, and unintentional weight loss. Further evaluation revealed a large left lower lobe mass and hilar lymphadenopathy. A computed tomography-guided biopsy of the lung mass revealed a multifocal non-necrotizing granuloma with multinucleated giant cells. Although consistent with sarcoidosis, this finding could represent a sarcoid-like reaction secondary to an occult malignancy. A more extensive repeat biopsy via bronchoscopy and mediastinoscopy revealed granulomatous inflammation without evidence of malignancy or infection. These procedures confirmed the diagnosis of pulmonary sarcoidosis, and she was started on treatment with high-dose prednisone. Her treatment course was complicated by hyperglycemia necessitating insulin therapy, but after 3 months of therapy, she reported improvement in her dyspnea, and repeat imaging revealed a significant decrease in the size of the lung mass and lymphadenopathy. Given her clinical and radiographic response, she was continued on a prednisone taper.
CONCLUSIONS: Atypical manifestations of pulmonary sarcoidosis are diagnostically challenging because the clinical and radiographic features of the disease mimic those of a malignancy. We aimed to illustrate a unique etiology of a lung mass and the importance of maintaining a broad differential diagnosis. Nonetheless, with the possibility of a malignancy, a high index of suspicion is necessary for timely diagnosis and optimal management.
PMID: 29650028 [PubMed - indexed for MEDLINE]