Management of Medically Compromised Prosthodontic Patients

The medical evaluation of patients considering prosthodontic treatment is a vital step in the treatment planning. The prosthodontist should be able to assess the inherent risks associated with the treatment of patients with systemic conditions. Many factors are associated with evaluating the patient’s health status and risk including the patient’s current and past medical and dental history, current and past use of medications, type of treatment, length of treatment, invasiveness of treatment, and degree of urgency of treatment. In this article, some of the systemic diseases like arthritis, cardiovascular diseases, endocrine disorders, hematologic and oncologic disease, neurologic disorders, bone disorders, pulmonary diseases, liver diseases, and chronic kidney disease that commonly affect aged individuals are reviewed. The prosthodontic considerations that should be taken care of while managing patients with these systemic conditions will also be discussed.

Gluten, Inflammation, and Neurodegeneration

Growing evidence supports a potential link between dietary gluten intake and neurodegenerative disease in susceptible populations. Observational data supporting this link are described along with interventional study data evaluating the effects of restricting gluten from the diet in patients with neurologic disorders. Suggested underlying mechanisms between gluten intake and neurodegeneration are discussed.

The utility of Coccidioides antigen and antibody detection in cerebrospinal fluid in the diagnosis of canine central nervous system coccidioidomycosis

OBJECTIVE To evaluate the utility of enzyme immunoassays (EIAs) for the detection of Coccidioides antigen and antibody in CSF in the diagnosis of CNS coccidioidomycosis in dogs. ANIMALS 51 dogs evaluated for CNS disease in a single specialty center in Tucson in 2016. PROCEDURES Excess CSF after routine analysis was banked after collection from dogs presented to the neurology service. Samples were tested by EIA for presence of Coccidioides antigen and antibody. Clinical data were collected from medical records retrospectively. RESULTS 22 dogs were diagnosed with CNS coccidioidomycosis (CCM) or another neurologic disease (non-CCM). These groups of dogs overlapped in the presenting complaints, MRI results, and routine CSF analysis results. Four dogs, all with CCM, had positive antigen EIA results. With clinical diagnosis used as the reference standard, CSF antigen testing had low sensitivity (20%) but high specificity (100%) for diagnosis of CCM. Ten dogs with CCM and 4 dogs with other diagnoses had antibody detected in CSF by EIA. Sensitivity of CSF antibody testing was 46%, specificity was 86%, and positive and negative predictive values for the study population were 71% and 68%, respectively. Clinical Relevance Diagnosis of CNS coccidioidomycosis in dogs in an endemic region was hampered by overlap of clinical signs with other neurologic disorders and the low sensitivity of confirmatory diagnostics. The evaluated Coccidioides-specific EIAs performed on CSF can aid in the diagnosis. A prospective study is warranted to corroborate and refine these preliminary findings

Pilot Study to Assess Changes in the Blink Reflex Across Age

ObjectiveThe objective was to conduct a preliminary study to access blink reflex parameters across age using the Eyestat.BackgroundThe blink reflex is a primitive brainstem response to an external stimulus is affected by multiple neurologic disorders, including those that affect the dopaminergic circuit that controls the eyelid. Our laboratory has utilized a potential objective measure to identify concussions within a college aged sport population called Eyestat, which measures changes in blink reflex parameters. Prior research cited significant differences in various blink reflex parameters between active play, concussion, and baseline. However, data with older, non-athlete populations has not defined.Design/MethodsOne hundred forty three subjects between the ages of 8–80 participated in this study. Once the subject was seated, the test sequence was initiated, in which the subject placed their face into the mask and 5 random air puffs were applied to the corner of the left or right eyes over a course of 20 seconds. High-speed videography (280 frames/sec.) captured the response of the subject's eyes before and after each stimuli.ResultsDescription statistics of the data indicated differences across age with the following parameters: Latency (ms): 46.02 (ages 8–21); 47.12 (ages 22–30); 48.96 (ages 31–40); 47.44 (ages 41–50); 55.20 (ages 51–60); and 55.39 (ages 61–80). Oscillations (qty): 14.10 (ages 8–21); 14.25 (ages 22–30); 12.19 (ages 31–40); 12.75 (ages 41–50); 9.98 (ages 51–60); and 9.78 (ages 61–80). Excursions (px): 127.57 (ages 8–21); 137.46 (ages 22–30); 135.34 (ages 31–40); 144.88 (ages 41–50); 147.72 (ages 51–60); and 148.85 (ages 61–80).ConclusionsAlthough more research is warranted to determine if these differences occur with a larger subject pool, this data substantiates the need for longitudinal assessments of the blink reflex as a potential biomarker, providing a non-invasive assessment of brain health in various populations.

P300 Evoked Response Potentials Patterns in Different Complex Concussion Phenotypes

ObjectiveDetermine the utility of P300 Evoked Response Potentials (ERP) voltage patterns in predicting phenotypical sequelae of patients with complex concussions or Persistent Post Concussive Symptoms (PPCS).BackgroundERPs have been used to aid in the diagnosis of multiple neurologic disorders. They have also been recently used in the evaluation of concussions.Design/MethodsA retrospective study of 54 patients, 10–71 year (mean age 29.6 yrs), with PPCS were tested between 6 and 12 weeks post-injury using the standard oddball audio P300 ERP protocol with measures extracted including best central parietal P300 ERP. PPCS Phenotyping was completed in each patient using a standardized post-concussive questionnaire and Rivermead method for 5 primary phenotypes and mixed type.ResultsP300 average Voltage for the entire group was 11.6 mV. Overall, these were significantly lower than age-matched non concussed controls whose average voltage was 16.3 mV (p < 0.0001). Average P300 voltages for each phenotype: Cognition- 14.1 mV, Vestibular- 8.6 mV, Headache- 11.1 mV, Mood- 13.6 mV, Neck Pain- 9.6 mV, Visual- 9.8 mV, Mixed- 6.9 mV, Mixed and Vestibular phenotypes demonstrated the lowest average voltage potentials (6.9 mV and 8.6 mV respectively) which coincided with higher average symptom scores (70.5 and 54.5 respectively). Cognition and Mood demonstrated the highest average voltage potentials (14.1 mV and 13.6 nV respectively), which coincided with lower average symptom scores (40.3 and 48.7, respectively). Mood (13.6 mV) was the lowest average symptom score in the group at 40.3 and Mixed (6.9 mV) was highest at 70.5. Comparing phenotypes against one other, mixed vs mood (p = 0.03), cognition vs vestibular (p = 0.02), and cognition vs mixed (p = 0.009) showed statistical significance.ConclusionsP300 ERPs may help identify persistent abnormal complex concussion neurophysiology. ERPs can also potentially exhibit phenotype specific patterns and be a useful tool in helping differentiate more somatic/physiologic vs mood-based phenotypes. This can ultimately lead in the aid in diagnosis, prognosis, subtyping, and targeted phenotype management.

Pathophysiology of Lipid Droplets in Neuroglia

In recent years, increasing evidence regarding the functional importance of lipid droplets (LDs), cytoplasmic storage organelles in the central nervous system (CNS), has emerged. Although not abundantly present in the CNS under normal conditions in adulthood, LDs accumulate in the CNS during development and aging, as well as in some neurologic disorders. LDs are actively involved in cellular lipid turnover and stress response. By regulating the storage of excess fatty acids, cholesterol, and ceramides in addition to their subsequent release in response to cell needs and/or environmental stressors, LDs are involved in energy production, in the synthesis of membranes and signaling molecules, and in the protection of cells against lipotoxicity and free radicals. Accumulation of LDs in the CNS appears predominantly in neuroglia (astrocytes, microglia, oligodendrocytes, ependymal cells), which provide trophic, metabolic, and immune support to neuronal networks. Here we review the most recent findings on the characteristics and functions of LDs in neuroglia, focusing on astrocytes, the key homeostasis-providing cells in the CNS. We discuss the molecular mechanisms affecting LD turnover in neuroglia under stress and how this may protect neural cell function. We also highlight the role (and potential contribution) of neuroglial LDs in aging and in neurologic disorders.

Gambaran Radiologis pada Bidang Neurologis Tumor Otak

Along with increasing life expectancy and advances in medical technology, the incidence of brain tumors continues to increase. Brain tumors can cause changes in mental status, neurological deficits, and create a large social burden. The incidence of benign brain tumors is 71% and these benign brain tumors develop twice as often in women as in men. Diagnosis brain tumors requires radiological examinations that can quickly diagnose brain tumors and must be done immediately. Source searches were carried out on the online portal of journal publications as many as 20 sources from MedScape, Google Scholar and the Nation Center for Biotechnology Information / NCBI with the keywords "brain tumor" and "radiology of brain tumor". Brain tumors cause progressive neurological disorders. Neurologic disorders in brain tumors are usually caused by two factors, namely focal disturbances due to tumors and increased intracranial pressure. The most commonly used radiological techniques are T1/T2-Weighted MRI, MR Spectroscopy, Diffusion MRI, Perfusion MRI, and Brain Tumor CT Scan. MRI is a powerful and flexible instrument for evaluating patients with primary brain tumors. Integration of the RANO criteria into treatment evaluation helps reduce premature discontinuation of effective therapy due to treatment-related imaging changes.