scholarly journals A Comparison of the Clinical and Radiological Extent of Denosumab (Xgeva®) Related Osteonecrosis of the Jaw: A Retrospective Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2390
Author(s):  
Zineb Assili ◽  
Gilles Dolivet ◽  
Julia Salleron ◽  
Claire Griffaton-Tallandier ◽  
Claire Egloff-Juras ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cumulative Incidence ◽  
Side Effect ◽  
Osteonecrosis Of The Jaw ◽  
Exposed Group ◽  
Severe Side Effect ◽  
Dental Arch ◽  
P Value ◽  
The Difference ◽  
Bone Exposure

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive medication. The aim of this study was to evaluate the incidence of denosumab-related osteonecrosis of the jaw and to compare the clinical and radiological extent of osteonecrosis. A retrospective study of patients who received Xgeva® at the Institut de Cancérologie de Lorraine (ICL) was performed. Patients for whom clinical and radiological (CBCT) data were available were divided into two groups: “exposed” for patients with bone exposure and “fistula” when only a fistula through which the bone could be probed was observed. The difference between clinical and radiological extent was assessed. The p-value was set at 0.05, and a total of 246 patients were included. The cumulative incidence of osteonecrosis was 0.9% at 6 months, 7% at 12 months, and 15% from 24 months. The clinical extent of MRONJ was significantly less than their radiological extent: in the “exposed” group, 17 areas (45%) were less extensive clinically than radiologically (p < 0.001) and respectively 6 (67%) for the “fistula” group (p < 0.031). It would seem that a CBCT is essential to know the real extent of MRONJ. Thus, it would seem interesting to systematically perform a CBCT during the diagnosis of MRONJ, exploring the entire affected dental arch.

Efficacy Comparison of Oral Versus Intravenous Busulfan in a BuCy Conditioning Regimen for Allogeneic BMT.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5042-5042
Author(s):  
Je-Hwan Lee ◽  
Seong-Jun Choi ◽  
Jung-Hee Lee ◽  
Miee Seol ◽  
Young-Shin Lee ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Cumulative Incidence ◽  
Medical Center ◽  
Conditioning Regimen ◽  
P Value ◽  
Allogeneic Bmt ◽  
Transfusion Requirements ◽  
Study Results ◽  
Asan Medical ◽  
Conditioning Therapy

Abstract Intravenous administration of busulfan (I-Bu) or targeted busulfan dosing has replaced oral administration of busulfan (O-Bu) in a conditioning therapy for BMT mainly due to erratic gastrointestinal absorption of oral busulfan. Several retrospective study results have demonstrated that use of I-Bu resulted in lower transplant-related morbidity and mortality compared to O-Bu, but the efficacy of I-Bu and O-Bu has not been compared. In this retrospective study, we compared the efficacy of I-Bu vs. O-Bu in a BuCy conditioning regimen for allogeneic BMT in a single institute. To avoid the bias of retrospective comparison, we restricted the patient eligibility to the followings: patients with AML having intermediate or poor cytogenetic risk groups at the time of diagnosis, those in the first complete remission at the time of BMT, those who were treated with BuCy conditioning regimen, and those who received bone marrow as a stem cell source. A total of 80 patients were eligible in this study among the patients who were transplanted at the Asan Medical Center between December 1993 and July 2007: 42 patients received O-Bu (4 mg/kg/d x 4d) and 38 patients received I-Bu (Busulfex, 3.2 mg/kg/d x 4d). The same dose of cyclophosphamide (60 mg/kg/d x 2d) was given to all the patients. We collected clinical and laboratory data from the BMT database of the Asan Medical Center. The efficacy was compared in terms of cumulative incidence of relapse (CIR), event-free survival (EFS), and overall survival (OS). Propensity score analysis was used to adjust the confounding factors between O-Bu and I-Bu groups. Several baseline clinico-laboratory factors at the time of BMT such as age, number of consolidation therapy prior to BMT, time from diagnosis to BMT, use of methotrexate for GVHD prophylaxis, and transfusion requirement before BMT were significantly different between 2 groups. Times to engraftment, transfusion requirements, infectious complications, hepatic VOD, and acute and chronic GVHD were similar between 2 groups. The cumulative incidence of non-relapse mortality was 14.3% in O-Bu group and 10.3% in I-Bu group (adjusted P-value, 0.990). The CIR at 4-year was 28.6% in O-Bu group and 16.9% in I-Bu group (adjusted P-value, 0.430). The 4-year probabilities of EFS and OS were 57.1% and 64.3% in O-Bu group and 72.6% and 69.3% in I-Bu group (adjusted P-values, 0.496 and 0.634, respectively). In summary, EFS and CIR were superior in I-Bu group compared to O-Bu group without statistical significance. Our results suggest that intravenous busulfan is as effective as oral busulfan in a conditioning therapy for BMT.

scholarly journals Different Presentation and Outcomes in the Surgical Treatment of Advanced MRONJ in Oncological and Nononcological Patients Taking or Not Corticosteroid Therapy

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Paolo Garzino Demo ◽  
Alessandro Bojino ◽  
Fabio Roccia ◽  
Maria Chiara Malandrino ◽  
Stefan Cocis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Surgical Treatment ◽  
Treatment Outcomes ◽  
Corticosteroid Therapy ◽  
Good Practice ◽  
Maxillofacial Surgery ◽  
Osteonecrosis Of The Jaw ◽  
Severe Side Effect ◽  
Antiresorptive Drugs

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect caused by antiangiogenic antiresorptive drugs used to treat various oncological and non oncological diseases. The clinical and radiological characteristics of MRONJ depend on the type of causative drug, the time of administration, and its dosage. Proven systemic risk factors like anemia, uncontrolled diabetes, corticosteroid therapy, and chemotherapy in neoplastic diseases (e.g., high doses of methotrexate up to 30 mg daily) significantly increase the chances of acquiring MRONJ. The risk factors themselves can affect treatment outcomes. Although the main scientific societies have recently disseminated good practice rules on the patient’s prevention, diagnosis, and management, there are still no guidelines on shared therapeutic strategies. In general, if conservative treatment fails, surgical treatment is considered, including local debridement, osteoplasty, and marginal or segmental osteotomy. In literature, cohorts of heterogeneous patients with MRONJ have been analyzed for a long time, resulting in a lack of uniformity of information and difficulties interpreting the data. According to the American Association of Oral and Maxillofacial Surgeons criteria, this retrospective study evaluates the surgical treatment outcomes of 64 patients with stage II-III MRONJ, evaluated at the Department of Maxillofacial Surgery of the University of Turin (Italy). The first objective of this retrospective study is to evaluate treatment results for stages II-III in all cases; the second objective is to evaluate the same results by dividing the sample into different cohorts of patients: first, based on the underlying pathology, i.e., oncological and non oncological, and secondly, based on the drug or combination of drugs they took.

A Comparative Evaluation of Rate of Space Closure Between Newer Generation Ceramic Brackets and Conventional Straight Wire Appliance

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
John Jr ◽  
Goutham Reddy ◽  
Anmol Kalha ◽  
Sunil Muddaiah ◽  
Sanju Somaiah ◽  
...  
Keyword(s):  
T Test ◽  
Dental Arch ◽  
P Value ◽  
Duration Of Treatment ◽  
Space Closure ◽  
Ceramic Brackets ◽  
The Difference ◽  
Clinically Significant ◽  
Digital Caliper ◽  
Closing Rate

Background: With the emerging concept of aesthetics in orthodontics, ceramic brackets play a major role especially in the anterior region of the dental arch. However, the duration of the orthodontic treatment is one of the most important issues in treating patients with ceramic brackets. Objectives: This study is conducted to compare space closing rate between conventional MBT and Symetri ClearTM bracket systems. Methods: This study is comprised of 18 subjects who were equally separated into two groups. The first group was treated with conventional MBT pre-adjusted bracket and the second group with Symetri ClearTM brackets. Space closure was performed via 0.019 × 0.025 inch stainless steel wires using 9-mm nickel-titanium Sentalloy coil springs with a constant force of 150 g. The distance between the distal of the first molar buccal tube and the mesial of the canine bracket was measured by a digital caliper. The difference of the first and last values was determined to assess the sheer quantity of space closure. The value was then divided by the number of months during which the space closure was carried out to examine the ratio of space closure in mm per month. For the statistical analysis we used paired t test as well as independent t test and the P-value > 0.05 was deemed significant. Results: The MBT group showed a 0.85 mm/appointment retraction rate while the Symetri ClearTM bracket group had a 0.83 mm/appointment retraction rate. The difference in space closing between MBT and Symetri ClearTM groups was not statistically and clinically significant (P-value > 0.05). Conclusions: As the rate of space closure was almost similar in the two types of brackets, we can use Symetri ClearTM brackets instead of MBT brackets without any concern about the duration of treatment and use the esthetic benefits of these brackets simultaneously.

Motivasi dan kepuasan kerja pegawai puskesmas BLUD dan non-BLUD Kabupaten Semarang

2018 ◽  
Vol 2 (3) ◽  
pp. 111
Author(s):  
Aswindar Adhi Gumilang ◽  
Tri Pitara Mahanggoro ◽  
Qurrotul Aini
Keyword(s):  
Public Health ◽  
Job Satisfaction ◽  
Financial Management ◽  
Work Motivation ◽  
P Value ◽  
The Public ◽  
The Status ◽  
The Difference ◽  
Demand For Health ◽  
Public Demand

The public demand for health service professionalism and transparent financial management made some Puskesmas in Semarang regency changed the status of public health center to BLUD. The implementation of Puskesmas BLUD and non-BLUD requires resources that it can work well in order to meet the expectations of the community. The aim of this study is to know the difference of work motivation and job satisfaction of employees in Puskesmas BLUD and non-BLUD. Method of this research is a comparative descriptive with a quantitative approach. The object of this research are work motivation and job satisfaction of employees in Puskesmas BLUD and non-BLUD Semarang regency. This Research showed that Sig value. (P-value) work motivation variable was 0.019 smaller than α value (0.05). It showed that there was a difference of work motivation of employees in Puskemas BLUD and non-BLUD. Sig value (P-value) variable of job satisfaction was 0.020 smaller than α value (0.05). It showed that there was a difference of job satisfaction of BLUD and non-BLUD. The average of non-BLUD employees motivation were 76.59 smaller than the average of BLUD employees were 78.25. The average of job satisfaction of BLUD employees were 129.20 bigger than the average of non-BLUD employee were 124.26. Job satisfaction of employees in Puskesmas BLUD was higher than non-BLUD employees.

Perbedaan Penggunaan Antikoagulan K2EDTA DAN K3EDTA Terhadap Hasil Pemeriksaan Indeks Eritrosit

2018 ◽  
Vol 1 (2) ◽  
pp. 114
Author(s):  
Wahdaniah Wahdaniah ◽  
Sri Tumpuk
Keyword(s):  
Screening Test ◽  
Venous Blood ◽  
The Body ◽  
Ethylene Diamine ◽  
P Value ◽  
Cross Sectional ◽  
Significant Difference ◽  
Ethylene Diamine Tetra Acetate ◽  
The Difference ◽  
Index Value

Abstract: Routine blood examination is the earliest blood test or screening test to determine the diagnosis of an abnormality. Blood easily froze if it is outside the body and can be prevented by the addition of anticoagulants, one of which Ethylene Diamine Tetra Acetate (EDTA). Currently available vacuum tubes containing EDTA anticoagulants in the form of K2EDTA and K3EDTA. K3EDTA is usually a salt that has better stability than other EDTA salts because it shows a pH approaching a blood pH of about 6.4. The purpose of this research is to know the difference of erythrocyte index results include MCH, MCV and MCHC using K3EDTA anticoagulant with K2EDTA. This research is a cross sectional design. This study used venous blood samples mixed with K2EDTA anticoagulant and venous blood mixed with K3EDTA anticoagulants, each of 30 samples. Data were collected and analyzed using paired different test. Based on data analysis that has been done on MCH examination, p value <0,05 then there is a significant difference between samples with K3EDTA anticoagulant with K2EDTA to erythrocyte index value. Then on the examination of MCV and MCHC obtained p value <0.05 then there is no significant difference between samples with K3EDTA anticoagulant with K2EDTA to erythrocyte index value.Abstrak: Pemeriksaan darah rutin merupakan pemeriksaan darah yang paling awal atau screening test untuk mengetahui diagnosis suatu kelainan. Darah mudah membeku jika berada diluar tubuh dan bisa dicegah dengan penambahan antikoagulan, salah satunya Ethylene Diamine Tetra Acetate (EDTA). Dewasa ini telah tersedia tabung vakum yang sudah berisi antikoagulan EDTA dalam bentuk  K2EDTA dan  K3EDTA. K3EDTA  biasanya berupa garam yang mempunyai stabilitas yang lebih baik dari garam EDTA yang lain karena menunjukkan pH yang mendekati pH darah yaitu sekitar 6,4. Tujuan dari penelitian ini adalah untuk mengetahui perbedaan hasil indeks eritrosit meliputi MCH, MCV dan MCHC menggunakan antikoagulan K3EDTA dengan K2EDTA. Penelitian ini merupakan penelitian dengan desain cross sectional. Penelitian ini menggunakan sampel darah vena yang dicampur dengan antikoagulan K2EDTA dan darah vena yang dicampur dengan antikoagulan K3EDTA, masing-masing sebanyak 30 sampel. Data dikumpulkan dan dianalisis menggunakan uji beda berpasangan. Berdasarkan analisis data yang telah dilakukan pada pemeriksaan MCH didapatkan nilai p < 0,05 maka ada perbedaan yang signifikan antara sampel dengan antikoagulan K3EDTA dengan K2EDTA terhadap nilai indeks eritrosit. Kemudian pada pemeriksaan MCV dan MCHC didapatkan nilai p < 0,05 maka tidak ada perbedaan yang signifikan antara sampel dengan antikoagulan K3EDTA dengan K2EDTA terhadap nilai indeks eritrosit.

scholarly journals Osteonecrosis of the jaw: a rare but possible side effect in thyroid cancer patients treated with tyrosine-kinase inhibitors and bisphosphonates

2021 ◽  
Author(s):  
L. Lorusso ◽  
L. Pieruzzi ◽  
M. Gabriele ◽  
M. Nisi ◽  
D. Viola ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Side Effect ◽  
Kinase Inhibitors ◽  
Osteonecrosis Of The Jaw ◽  
Antiangiogenic Agents ◽  
Neoplastic Disease ◽  
External Radiation Therapy ◽  
Serious Disease

AbstractOsteonecrosis of the jaw (ONJ) is a rare but very serious disease that can affect both jaws. It is defined as exposed bone in the maxillofacial region that does not heal within 8 weeks after a health care provider identification. ONJ can occur spontaneously or can be due to drugs like bisphosphonates (BPS) and anti-RANK agents, in patients with no history of external radiation therapy in the craniofacial region. Although in phase 3 trials of tyrosine kinase inhibitors (TKIs) used in thyroid cancer (TC) the ONJ was not reported among the most common side effects, several papers reported the association between ONJ and TKIs, both when they are used alone and in combination with a bisphosphonate. The appearance of an ONJ in a patient with metastatic radio-iodine refractory differentiated TC, treated with zoledronic acid and sorafenib, has put us in front of an important clinical challenge: when a ONJ occurred during TKIs treatment, it really worsens the patients’ quality of life. We should consider that in the case of ONJ a TKI discontinuation becomes necessary, and this could lead to a progression of neoplastic disease. The most important aim of this review is to aware the endocrinologists/oncologists dealing with TC to pay attention to this possible side effect of BPS and TKIs, especially when they are used in association. To significantly reduced the risk of ONJ, both preventive measures before initiating not only antiresorptive therapy but also antiangiogenic agents, and regular dental examinations during the treatment should always be proposed.

Planning for End of Life

2021 ◽  
pp. 104990912110141
Author(s):  
Natasha Ansari ◽  
Eric Johnson ◽  
Jennifer A. Sinnott ◽  
Sikandar Ansari
Keyword(s):  
End Of Life ◽  
Treatment Options ◽  
Stage Iv ◽  
P Value ◽  
Life Planning ◽  
Number Of Patients ◽  
End Of Life Planning ◽  
The Difference ◽  
Alternative Medications ◽  
Patient’S Perception

Background: Oncology provider discussions of treatment options, outcomes of treatment, and end of life planning are essential to care for patients with advanced malignancies. Studies have shown that despite this, many patients do not have adequate care planning, including end of life planning. It is thought that the accessibility of information outside of clinical encounters and individual factors and/or beliefs may influence the patient’s perception of disease. Aims: The objective of this study was to evaluate if patient understanding of treatment goals matched the provider and if there were areas of discrepancy. If a discrepancy was found, the survey inquired further into more specific aspects. Methods: A questionnaire-based survey was performed at a cancer hospital outpatient clinic. 100 consecutive and consenting patients who had stage IV non-curable lung, gastrointestinal (GI), or other cancer were included in the study. Patients must have had at least 2 visits with their oncologist. Results: 40 patients reported their disease might be curable and 60 reported their disease was not curable. Patients who reported their disease was not curable were more likely to be 65 years or older (P-value: 0.055). They were more likely to report that their doctor discussed the possibility of their cancer getting worse (78.3% VS 55%; P-value 0.024), that their doctor discussed end of life plans (58.3% VS 30%; P- value: 0.01), and that they had appointed a health care decision-maker (86.7% VS 62.5%; P-value: 0.01). 65% of patients who thought their disease might be curable reported that their doctor said it might be curable, compared with only 6.7% of patients who thought their disease was not curable (p < 0.001). Or, equivalently, 35% of patients who thought their disease might be curable reported that their doctor’s opinion was that it was not curable, compared with 93% of patients who thought their disease was not curable (p < 0.001). Patients who had lung cancer were more likely to believe their cancer was not curable than patients with gastrointestinal or other cancer, though the difference was not statistically significant (p = 0.165). Patients who said their disease might be curable selected as possible reasons that a miracle (50%) or alternative medicine (66.7%) would get rid of the cancer, or said their family wanted them to believe the cancer would go away (16.7%) or that another doctor said it would (4.2%). Patients who said their disease might be curable said they did so due to alternative medications, another doctor, or their family. Restricting to the 70 patients who reported their doctors telling them their disease was not curable, 20% of them still said that they personally felt their disease might be curable. Patients below 65 years of age were more likely to disagree with the doctor in this case (P-value: 0.047). Conclusion: This survey of patients diagnosed with stage IV cancer shows that a significant number of patients had misunderstandings of the treatment and curability of their disease. Findings suggest that a notable proportion kept these beliefs even after being told by treating physicians that their disease is not curable.

scholarly journals Influence of preoperative corticosteroid treatment on rate of diagnostic surgeries in primary central nervous system lymphoma: a multicenter retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Florian Scheichel ◽  
Franz Marhold ◽  
Daniel Pinggera ◽  
Barbara Kiesel ◽  
Tobias Rossmann ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Retrospective Study ◽  
Diagnostic Delay ◽  
Central Nervous System Lymphoma ◽  
Corticosteroid Treatment ◽  
Histopathological Diagnosis ◽  
Significant Difference ◽  
The Difference ◽  
Immunocompetent Patients

Abstract Background Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSL patients with and without preoperative CST. Methods A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. Results A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSL patients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7–6.4). Conclusions Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSL patients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.

scholarly journals Characteristics of patients with osteonecrosis of the jaw with oral versus intravenous bisphosphonate treatment

2021 ◽  
Vol 43 (1) ◽  
Author(s):  
Seung-Hun Lee ◽  
So-Young Choi ◽  
Min-Su Bae ◽  
Tae-Geon Kwon
Keyword(s):  
Retrospective Study ◽  
Clinical Characteristics ◽  
Demographic Data ◽  
Osteonecrosis Of The Jaw ◽  
Group Differences ◽  
Bisphosphonate Treatment ◽  
Administration Route ◽  
Lesion Number ◽  
Different Characteristics ◽  
Intravenous Bisphosphonate

Abstract Purpose This retrospective study was aimed to evaluate the clinical characteristics and treatment outcomes in patients with osteonecrosis of the jaw who were receiving oral versus intravenous (IV) bisphosphonate (BP). Materials and methods This retrospective study enrolled subjects who had been diagnosed with medication-related osteonecrosis of the jaw (MRONJ) during the period from July 2010 to June 2014. Information regarding the following demographic and clinical characteristics was collected: demographic data, administration route and type of BP, duration of BP medication, primary disease, number of involved sites, location of the lesion, number of surgeries, outcome of treatments, and laboratory test. All the patients were divided into oral and IV BP groups; and the between-group differences were compared. Results Total 278 patients were divided into two groups as per the route of BP administration. The proportion of oral BP-related MRONJ group were more dominant over IV BP group (oral BP, n = 251; IV BP, n = 27). In the IV BP group, the average dosing duration (31.4 months) was significantly shorter than that in the oral BP group (53.1 months) (P < 0.001). The average number of involved sites in the oral BP group (1.21 ± 0.48) was smaller than that in the IV BP group (1.63 ± 0.84) (P < 0.001). The average number of surgeries was higher in the IV BP group (1.65 ± 0.95) as compared to that in the oral BP group (0.98 ± 0.73) (P < 0.001). Outcome after the surgery for MRONJ after IV BP was poor than oral BP group. Conclusion IV administration of BP causes greater inhibition of bone remodeling and could lead more severe inflammation. Therefore, even if the duration of IV administration of BP is shorter than that of oral BP, the extent of the lesion could be more extensive. Therefore, the result suggests that the MRONJ after IV BP for cancer patients needs to be considered as different characteristics to oral BP group for osteoporosis patents.

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