Changing Time Horizons and Trust: Experiences of Aging With Hemophilia

Trust among those who have experienced a lifetime of medical encounters warrants attention to how trust is both cumulative and complex. This study of a historically isolated cohort incorporates interviews (n=25 older adults/professionals) and focus groups uses a lens of trust to highlight the experiences of those aging with hemophilia, individuals who never expected to age. Understood through the lens of trust, the data show evidence of the absence of safe spaces particularly during the early 80s - blood contamination concerns and homophobia-leading often to social withdrawal. Over time, however, some individuals and families created trusted venues to begin demanding research, treatment and policy change. Advocacy re-engaged the community to organize, educate and advance safety protocols for blood product manufacturing and distribution. This presentation will illuminate how experiences with medical providers, contaminated blood supplies, stigma and uncertain in other spheres of one’s life make trust a co-constructed, fragile concept.

Optimal Techniques for EUS-Guided Fine-Needle Aspiration of Pancreatic Solid Masses at Facilities without On-Site Cytopathology: Results from Two Prospective Randomised Trials

Background: EUS-guided fine-needle aspiration (EUS-FNA) has emerged as the primary modality for the cytologic diagnosis of pancreatic solid masses. The aim of this study is to determine whether technical factors including suction (S), non-suction (NS), capillary sampling with stylet slow-pull (CSSS), and the number of needle actuations (to-and-fro needle movements) may affect the accuracy of EUS-FNA for pancreatic solid masses at facilities without on-site cytopathology. Methods: The diagnostic yield of malignancy, blood contamination and cellularity at each sample acquired from EUS-FNA with or without S and different numbers of actuation (10, 15 and 20) were measured (study I). The optimal actuation number was determined and a head-to-head comparison trial between S and CSSS was performed (study II). Results: In study I, significant blood contamination was seen using S with 20 compared with 15 actuations (p = 0.002). Diagnostic yield of malignancy was not significantly different between 10, 15, and 20 actuations with S, whereas it was statistically higher for 15 actuations compared with 10 actuations with NS (p = 0.001). In study II, no difference was noted in diagnostic yield with 15 actuations between S and CSSS (88% vs. 90%, p = 0.74). Conclusions: Increasing actuation in NS resulted in a better diagnostic yield for EUS-FNA without significant blood contamination, whereas increasing actuation in S did not change the diagnostic yield of EUS-FNA while causing significant blood contamination. With 15 actuations, the diagnostic yield was comparable between S and CSSS.

Accuracy of Endoscopic Ultrasound Guided Fine Needle Aspiration In Sampling Of Pancreatic & Gastrointestinal Lesions Using Capillary Versus Suction Technique

Background Endosonography (EUS) evolved from purely diagnostic imaging modality to be a method that allows tissue acquisition and therapeutic intervention. EUS-guided fine needle aspiration (EUS-FNA) permits cytological confirmation of imaging findings and is performed with high sensitivity and specificity in addition to low incidence of adverse events. Standard EUS-FNA involve use of either no-suction or suction techniques. New sampling technique; capillary (stylet slow-pull) technique, involves slow withdrawal of the stylet creating a small negative pressure. Aim of the work The aim of this study is to compare the quality of samples acquired by capillary technique versus suction technique using 22-gauge needles. Patients and methods Patients referred for EUS-FNA for upper gastrointestinal lesions (pancreatic or luminal) were included in the study. Each lesion was sampled twice, the first was taken using suction technique (applying negative pressure suction using standard 10 ml syringe) while the second one by capillary (stylet slow-pull) technique. After sample processing and staining, cytopathologist reviewed the material blinded to the technique used. The quality of samples was assessed regarding 3 aspects; cellularity, sample contamination by blood or mucosal cells. Results A total of 51 patients (37/14 males/females, mean age 55.4) referred for EUSFNA were included. Cytological diagnosis was: pancreatic adenocarcinoma in 38/51 (74.51%), Gastrointestinal stromal tumor in 4/51 (7.84%), inconclusive result in 3/51 (5.88%), the rest were solid pseudopapillary neoplasm, Serous cystic neoplasm, Mucinous cystic neoplasm, inflammatory lesions (papillitis, pancreatitis) and metastatic lesion 1 patient for each (1.96%). The sample cellularity score showed no statistically significant difference between both sampling techniques (P = 0.18). Blood contamination score was significantly lower in the capillary technique (P < 0.0001) indicating more blood contamination in suction technique samples. Conclusion Both techniques provided comparable diagnostic performance. However, capillary technique showed less sample contamination by blood cells resulting in a slightly better-quality sample.

Influence of Blood Contamination on Push-Out Bond Strength of Three Calcium Silicate-Based Materials to Root Dentin

A proper bond between root canal filling materials and dentin surface is essential to resist dislodgement and guarantee long-term success. Blood exposure is likely to occur in various clinical situations in which calcium silicate-based materials are used; therefore, it is fundamental to render data concerning the influence of blood on bond strength. The present study aims to evaluate the effect of blood contamination on the push-out bond strength obtained with three different biomaterials to root canal dentin; Ninety extracted human mono-radicular permanent teeth were selected. The root canals were prepared with Gates Glidden burs until a diameter of 1.10 mm was achieved. Teeth were then randomly divided into six experimental groups (n = 15) according to the presence/absence of blood contamination and biomaterial used for root canal filling (ProRoot® MTA, BiodentineTM, and TotalFill® BC Putty). After one week, each root was sectioned in three segments (coronal, middle, and apical regions). Specimens were then submitted to push-out bond strength tests. Fracture pattern evaluation was performed. The significance level was set at 5%.; Blood contamination did not affect the push-out bond strength of any of the three tested calcium silicate-based cements (p > 0.05). Regardless of blood contamination, TotalFill showed statistically higher push-out bond strength when compared with Biodentine (p = 0.040) and MTA (p = 0.004). Biodentine exhibited higher bond strength than MTA (p = 0.043). Biomaterials’ comparison within each radicular segment revealed statistically superior bond strength of both Biodentine and TotalFill over MTA (p < 0.05) in the coronal segment. TotalFill presented higher push-out bond strength regarding the apical segment compared to Biodentine (p = 0.003). Fractures were mostly adhesive.; Overall results indicate TotalFill presents the highest push-out bond strength values, followed by Biodentine and, lastly, MTA. Blood contamination did not affect the dislodgement resistance. Biomaterials’ comparison within each radicular segment revealed both TotalFill and Biodentine as the preferable alternatives for application in the coronal region. TotalFill might be the biomaterial of choice for placement in the apical region.

A literature review on precautionary measures in dental practice during the pandemic: Covid-19

During the spread of pandemic disease, dental practice come across the highest risk of corona virus infection by the exposure from patient saliva, aerosols generation during the dental procedure, blood contamination during oral surgical procedure. This virus can be transmitted from symptomatic to asymptomatic individual through aerosol spread, saliva contamination. Due to its ability of airborne transmission, so aerosols generated through natural activity or during the time of any dental treatment procedure has the ability to transmit the virus from infected person to the surrounding person.