The Risk of Nonsteroidal Anti-Inflammatory Drugs in Pediatric Medicine: Listen Carefully to Children with Pain

Over the last decades, the use of over-the-counter analgesics in the general population has increased in Germany. Ibuprofen is one of the most commonly used nonsteroidal anti-inflammatory drug (NSAID) and is frequently prescribed to children as an analgesic and/or antipyretic. Besides having a well-established safety and efficacy profile when used in appropriate doses, cases of NSAID-induced acute kidney injury (AKI) have been described in the pediatric population, particularly in the context of dehydration and in combination with other drugs. The ingestion of more than 400 mg/kg is associated with severe or life-threatening toxicity. This report is about two previously healthy adolescents, who developed AKI after taking high daily dose of ibuprofen as a pain reliever without any appropriate medical supervision. With these case reports, in addition to the side effect profiles of this analgesic, we would also like to present a certain therapeutic recommendation that we applied in these patients, and furthermore appeal to pediatricians to strictly set the indications for ibuprofen intake.

Oral Pathology - The Soul of Dentistry

BACKGROUND Oral and maxillofacial pathology, is the very foundation of dentistry. It is a branch of dentistry where research meets clinical practice with the use of histopathology, cytopathology, haematology, immunohistochemistry, clinical biochemistry, microbiology, molecular science, forensic odontology, and a lot more, making it a unique and rare branch in its own way. It acts as a backbone of dental science, by investigating the causes, processes, and effects of the disease affecting the oral and maxillofacial region. Therefore, this branch requires timely up-gradation to analyse health data, research findings and treatment techniques to offer a diagnostic and therapeutic recommendation for individual patients. The application of digital technology in oral pathology is on the verge of becoming a standard of care, thereby eliminating the need for practising pathology on a conventional microscope. Globally, pathological laboratories need to be more efficient than before. Therefore, automation and digitalization are required to not only increase the efficiency, growth, quality, and capacity but also to standardise the processes. The purpose of this article is to introduce the readers, the incorporation of new ideas and technologies in the lab for a better and faster diagnosis, and would also like to explain the concept of standardizing the method of recording and maintaining the dental or medical records of the patients, and also standardizing the lab reports. KEY WORDS Innovation, Robotics, Digitalization, Artificial Intelligence, Upgradation, Maxillofacial Region

Treatment of the behavioral variant of frontotemporal dementia: a narrative review

ABSTRACT Frontotemporal dementia (FTD) is a progressive neurodegenerative disorder accompanied by behavioral and personality changes and/or language deterioration. Its behavioral variant (bvFTD) is the main clinical presentation. Objective: This study aims to investigate the treatment alternatives for bvFTD available so far. Methods: We conducted a narrative review of bvFTD treatment options. We used PubMed and Lilacs databases with the terms “frontotemporal dementia” or “behavioral variant frontotemporal dementia” combined with “treatment,” “pharmacological treatment,” or “disease-modifying drugs.” Results: The articles retrieved and selected in the research pointed out that there is no specific treatment approved for bvFTD so far. The current proposals are limited to handle the cardinal behavioral symptoms of the disorder. Disease-modifying drugs are under development and may be promising, especially in the monogenic presentations of FTD. Conclusions: There are numerous approaches to treat the core symptoms of bvFTD, most of them based on low-quality research. To date, there are no drugs with a disease-specific therapeutic recommendation for bvFTD. Treatments are often investigated guided by primary psychiatric disorders with similar symptoms and should be chosen by the predominant symptom profile.

Nisin activity against methicillin-resistant and methicillin-sensitive Staphylococcus aureus and risk of resistance acquisition

The objective of this study was to analyze the antimicrobial effect of nisin against MRSA (Methicillin-Resistant Staphylococcus aureus) and MSSA (Methicillin-Sensitive Staphylococcus aureus), and at the same time examine the possibility of the bacteria to develope nisin resistance. The antimicrobial susceptibility of the strains was tested using the agar diffusion and/or microdilution methods. To select nisin-resistant strains, bacteria were grown consecutively at sublethal concentrations of the bacteriocin. Nisin showed bactericidal activity against most of the tested strains. MRSA required higher doses of bacteriocin compared to MSSA both for inhibition and cell death. However, transfers in the presence of nisin could completely eliminate nisin activity with an increase in minimal inhibitory concentration value of up to 250 times. Nisin-resistance could be maintained in MRSA and MSSA even in the absence of the bacteriocin. Nisin resistance affected antibiotic susceptibility of both MRSA and MSSA to mainly Cefoxitin, Oxacillin, and Erythromycin. These results indicate that nisin-resistance is a complex trait among MSSA and MRSA and must be elucidated before the therapeutic recommendation of nisin to treat infections caused by these bacterial species.

Feasibility of preemptive pharmacogenetic testing in colorectal cancer patients within a community oncology setting

Introduction Pharmacogenetics, in hand with precision medicine in oncology, represents an opportunity to holistically tailor a patient’s treatment regimen using both somatic and germline variants to improve efficacy and decrease toxicity. Colorectal cancer patients represent a population with frequent use of fluoropyrimidine and irinotecan and are an ideal opportunity for implementation of preemptive pharmacogenetics as evidence supports pharmacogenetic testing for DPYD and UGT1A1 to reduce fluoropyrimidine and irinotecan toxicities. Methods This was a single arm proof-of-concept study at a large community-based health system. Participants provided samples for pharmacogenetic testing via an external vendor prior to chemotherapy initiation and an oncology pharmacist was responsible for pharmacogenetic interpretation and pharmacogenetic-guided therapeutic recommendation to the treating provider. Results A total of 24 (60%) participants had a UGT1A1 variant. All participants (100%) were DPYD*1/*1. Results were available and interpreted for 29/40 (72.5%) participants prior to scheduled chemotherapy initiation (p value <0.014). Of the participants whose results were available in 5 weekdays or less (n = 23), 20 (87%) were communicated with the treating provider prior to scheduled chemotherapy administration. A total turnaround time of 5 days or less was significantly associated with PGx feasibility in a community-based oncology clinic (p = 0.03). Conclusions In conclusion, we were able to show that implementation of preemptive pharmacogenetic testing into a community oncology clinic with results interpretation available prior to scheduled initiation of chemotherapy was feasible. As pharmacogenetic testing in oncology expands, pharmacists should be prepared to optimize supportive medication regimens as well as chemotherapy with pharmacogenetic results.

Clinical Efficacy of Combination Therapy for the Treatment of Severe Infections Caused by Carbapenem Resistant Gram-Negatives. A Systematic Review of Clinical Studies

Background: The combination of antibiotics has become the clinicians’ preferred strategy for the treatment of sepsis due to carbapenem-resistant Gram-negative bacteria (CR-GNB) although the evidence supporting its use is weak. This systematic review aimed at critically evaluating all available antibiotic options for CR-GNB sepsis with particular focus on combination. Methods: Comparative and non-comparative observational studies, randomized control trials (RCTs) and case series were considered eligible with no language restriction. Studies were included if reporting microbiologically-confirmed sepsis caused by Acinetobacter baumannii, Enterobacterales/Klebsiella spp., or Pseudomonas aeruginosa, reporting at least one of the study outcome and targeted antibiotic treatment. Carbapenem-resistance was defined as phenotypically-detected in vitro resistance to at least one of the following carbapenems: doripenem, ertapenem, imipenem, meropenem. Primary outcomes were 30-day and attributable mortality. Bayesian network meta-analysis (NMA) approach was selected to explore feasibility of pooling data on antibiotic regimens. Results: A total of 6306 records were retrieved and 134 studies (11546 patients) were included [54 studies on Acinetobacter, 52 on Enterobacterales/Klebsiella, 21 on mixed Gram-negative, and 7 on Pseudomonas]. Nine (7%) were RCTs; 19 prospective cohorts (14%), 89 (66%) retrospective and 17 (13%) case series. Forty-one studies (31%) were multicentric. Ninety-two distinct regimens were identified with 47 (51%, 5863 patients) not reporting any details on combination. 30-day mortality was assessed in 65 (48%) studies while attributable mortality was reported only in 19 (14%).The NMAs were not applicable for any of selected outcomes given the presence of too many disconnected components. Conclusion: The existing evidence is too weak for allowing formulating any evidence-based therapeutic recommendation for combination of antibiotics to treat CR-GNB sepsis. Future studies must clearly define number, type, dosages, and in vitro activity of each antibiotic included in the regimen to drive recommendations for using combination of antibiotics that might be reliably applied into clinical practice.

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.

Abdominal symptoms during Sjogren’s syndrome: a pilot study

Background Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease. Methods One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected. Results Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ± 5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjögren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p < 0.01). Multivariate analysis showed a significant association between a high global symptom score and SSA seronegativity, gastroparesis, and ESSPRI score (p < 0.01 for each). Conclusions The majority of patients with pSS suffered abdominal symptoms. There is currently no therapeutic recommendation because of the lack of information on the underlying pathophysiological mechanisms. Trial registration NCT03157011. Date of registration: July 17, 2017.

Demystifying Grief in the Dementia Divide: A Case for Grief Therapy in Dementia Care

The results of emotional and psychological losses overlap with behavioral and psychological symptoms of dementia (BPSD) in the neuronal and structural changes in the brain. The aim of this current study was to explore the magnifying effects of COVID-19 on exacerbating residual losses, illuminating a case for using grief therapy to moderate BPSD. A case control study was conducted with people ages 65 and greater, with an established diagnosis of dementia prior to March 2020. Compared with an active control group - participants without a current dementia diagnosis who self-reported mild cognitive shifts and who also received active grief-informed therapies – offer supporting evidence of a strong factor of efficacy for including grief therapy in services offered to people living with dementia. Evidence of a continued point improvement on both the brief grief questionnaire and inventory of complicated grief, as well as decreased severity of items on NPI-Q corroborate this therapeutic recommendation. Now more than ever – as people across the globe who are diagnosed with dementia face uncertain ramifications of previous grief episodes, ones that have potentially been reignited by the flames of COVID-19 – therapists must foster safe spaces informed by novel therapeutic grief approaches. In any just society, emphasis on therapeutic techniques that allow participants to ventilate their feelings and fears, as well as promote movement along a continuum from isolation to intimacy, must prevail. People exhibiting BPSD should not be excluded from such treatments.

Congenital Nephrotic Syndrome of The Finnish Type with Crescent Formation: A Challenging Case and Ultrasonographic Findings.

Background: Congenital nephrotic syndrome of the Finnish type has been probably observed in Iraqi children, but it was not reported or documented in the scientific literature. The aim of this paper is to report the rare occurrence of congenital nephrotic syndrome of the Finnish type in association with crescents formation. Interesting ultrasonographic findings are also reported, and an evidence-based therapeutic recommendation for Iraqi patients is described. Patients and methods: A four-month male infant with congenital nephrotic syndrome was referred with a request for therapeutic recommendation. Ultrasound study was performed. The ultrasound specialist thought that the ultrasound diagnosis could be medullary sponge kidney because of the presence of hyperechoic medulla. The ultrasound finding was considered, but the ultrasound specialist diagnosis was not taken as it was not correlated with the clinical diagnosis of nephrotic syndrome. Results: The ultrasound finding was considered, but the ultrasound specialist diagnosis was not taken as it was not correlated with the clinical diagnosis of nephrotic syndrome. Renal biopsy showed the classic diagnostic histopathological findings congenital nephrotic syndrome of the Finnish type. In addition, biopsy showed the rare occurrence of crescents formation in the congenital nephrotic syndrome of the Finnish type. Conclusion: The rare occurrence of congenital nephrotic syndrome of the Finnish type in association with crescents formation is reported and supplemented with interesting ultrasonographic findings.