Continuous Multidisciplinary Care for Patients With Orofacial Clefts—Should the Follow-up Interval Depend on the Cleft Entity?

Objective The multidisciplinary follow-up of patients with cleft lip with or without palate (CL/P) is organized differently in specialized centers worldwide. The aim of this study was to evaluate the different treatment needs of patients with different manifestations of CL/P and to potentially adapt the frequency and timing of checkup examinations accordingly. Design We retrospectively analyzed the data of all patients attending the CL/P consultation hour at a tertiary care center between June 2005 and August 2020 ( n = 1126). We defined 3 groups of cleft entities: (1) isolated clefts of lip or lip and alveolus (CL/A), (2) isolated clefts of the hard and/or soft palate, and (3) complete clefts of lip, alveolus and palate (CLP). Timing and type of therapy recommendations given by the specialists of different disciplines were analyzed for statistical differences. Results Patients with CLP made up the largest group ( n = 537), followed by patients with cleft of the soft palate ( n = 371) and CL ± A ( n = 218). There were significant differences between the groups with regard to type and frequency of treatment recommendations. A therapy was recommended in a high proportion of examinations in all groups at all ages. Conclusion Although there are differences between cleft entities, the treatment need of patients with orofacial clefts is generally high during the growth period. Patients with CL/A showed a similarly high treatment demand and should be monitored closely. A close follow-up for patients with diagnosis of CL/P is crucial and measures should be taken to increase participation in follow-up appointments.

Problematic Use of Nitrous Oxide by Young Moroccan–Dutch Adults

The recreational use of nitrous oxide (N2O; laughing gas) has largely expanded in recent years. Although incidental use of nitrous oxide hardly causes any health damage, problematic or heavy use of nitrous oxide can lead to serious adverse effects. Amsterdam care centres noticed that Moroccan–Dutch young adults reported neurological symptoms, including severe paralysis, as a result of problematic nitrous oxide use. In this qualitative exploratory study, thirteen young adult Moroccan–Dutch excessive nitrous oxide users were interviewed. The determinants of problematic nitrous oxide use in this ethnic group are discussed, including their low treatment demand with respect to nitrous oxide abuse related medical–psychological problems. Motives for using nitrous oxide are to relieve boredom, to seek out relaxation with friends and to suppress psychosocial stress and negative thoughts. Other motives are depression, discrimination and conflict with friends or parents. The taboo culture surrounding substance use—mistrust, shame and macho culture—frustrates timely medical/psychological treatment of Moroccan–Dutch problematic nitrous oxide users. It is recommended to use influencers in media campaigns with the aim to decrease the risks of heavy nitrous oxide use and improve treatment access. Outreach youth workers can also play an important role in motivating socially isolated users to seek medical and or psychological help.

Medical Diagnoses, Mode of Residence, and Dental Treatment Demand under General Anesthesia in Special Needs Adults in Innsbruck, Austria. A Retrospective Breakdown of Four and a Half Years

Regarding oral/dental care and attendance, special needs individuals depend on their caregivers’ commitment. The purpose of this retrospective data analysis of adults who received dental general anesthesia (DGA) in Innsbruck, Austria, was a breakdown of demographic parameters (including the mode of accommodation/care), medical diagnoses (comprising intellectual/physical disablement (IPD) or psychiatric (anxiety) disorders (PDs)), and dental therapy performed under DGA. The sample was composed of 233 consecutive adults who underwent DGA from January 2015 to June 2019. Data were analyzed with descriptive and comparative statistics. In total, 133 (57.1%) subjects were male and 100 (42.9%) female; 176 (75.5%) had IPD and 57 (24.5%) PDs; 168 (72.1%) were living at private and 65 (27.9%) at nursing homes. Median age (IQR) was 35.6 (25.7–47.2) years. In the total sample, 5 (2–9) teeth were restored and 2 (0.5–6.5) teeth were extracted. Individuals with PDs had more teeth restored (p = 0.01) and extracted (p < 0.001) than individuals with IPD. Private home residents had more teeth restored (p < 0.001) but less teeth extracted (p = 0.003) than nursing home residents. Special needs individuals’ oral health backlog should be tackled in private and institutional care modalities alike.

Clinical Follow-Up in Orofacial Clefts—Why Multidisciplinary Care Is the Key

(1) Background: Although most clinicians involved in the treatment of cleft patients agree upon the major importance of interdisciplinary cooperation and many protocols and concepts have been discussed in the literature, there is little evidence of the relevance of continuous interdisciplinary care. We aimed to objectify the type and number of therapeutic decisions resulting from an annual multidisciplinary follow-up. (2) Methods: We retrospectively analyzed the data of all 1126 patients followed up in the weekly consultation hours for cleft patients at university clinics in Leipzig for the years 2005–2020. We assessed the clinical data of every patient and specifically evaluated the treatment decisions taken at different points in time by the participating experts of different specialties. (3) Results: In total, 3470 consultations were included in the evaluation, and in 70% of those, a therapeutic recommendation was given. Each specialty showed certain time frames with intense treatment demand, which partially overlapped. Nearly all therapy recommendations were statistically attached to a certain age (p < 0.001). (4) Conclusions: There is an exceptionally high need for the interdisciplinary assessment of patients with cleft formation. Some developmental phases are of particular importance with regard to regular follow-up and initiation of different treatment protocols. The therapy and checkup of cleft patients should be concentrated in specialized centers.

An Open-label Randomized Control Trial Comparing Clonidine and Buprenorphine for Medically-Assisted Opium Withdrawal of Adolescents

Background: There is an increasing trend in treatment demand for opioid dependence among adolescents in Iran. However, evidence regarding effective treatment in this population is very limited. Objectives: This study aimed to compare the efficacy of clonidine and buprenorphine for inpatient medically-assisted withdrawal of adolescents with opioid dependence aged 12 and 16 years. Materials and Methods: The study is an open-label, randomized controlled trial with convenience sampling. In total, 36 adolescents took part in this study who were randomly assigned to buprenorphine or clonidine groups. The Clinical Opiate Withdrawal Scale was used to monitor the withdrawal severity on days one, two, three, seven, and 14. Results: The findings showed both treatments were effective. However, withdrawal symptoms in the buprenorphine group showed a greater reduction in the first seven days of withdrawal treatment. There was no significant difference in the length of hospitalization between the two groups. Patients with a longer duration of opioid use showed higher levels of withdrawal symptoms in the buprenorphine group on days one and three. Conclusions: Buprenorphine treatment was found to be more effective than clonidine in controlling opioid withdrawal during the initial days of treatment. However, it lost its superiority towards the end of the follow-up. It seems that clonidine could be a good alternative to buprenorphine in the medically-assisted withdrawal of adolescents with opioid dependence.

Current Trends in Epidemiology of Rabies in Belarus

Relevance. According to expert estimates, tens of thousands of people die every year from rabies infection, mainly in Asia and Africa, for whom the main source of transmission of the virus is dogs.The purpose of the work is to establish the epidemiological characteristics of rabies infection in Belarus from 2013 to 2018 in the absence of cases of rabies among the population. Materials and methods. A retrospective epidemiological analysis of treatment demand for anti-rabies medical care (ARMС), analysis of data on an epizootic situation was applied.Results and discussion. The population treatment demand for ARMС ranged from 209.60/0000 to 227.20/0000 and was characterized by higher rates 1.6–1.7 times (P ≤ 0.05) among people under the age of 18. The results of monitoring the epizootic situation of rabies revealed that among all wild animals the proportion of «fox» rabies was 80.7%, while 94.4% of the patients were injured by dogs and cats. In 2018 has increased in 3.3 times (P ≤ 0.02) the frequency of treatment persons with the 3rd damage category and in 1.6 increase (P ≤ 0.05) in the proportion of rabies of farm animals in the structure of the reasons for applying for ARMС in comparison with 2013.Conclusion. In Belarus, the relevance of the problem of rabies infection is determined by the activity of the epizootic process, the consistently high treatment demand for ARMС, the events of contacts of the population, including mass, with rabies animals, the annual increase in the frequency of registration of the 3rd category of damage, as well as refusals of immunization and spontaneous interruption of preventive immunization by patients.