Caregiver burden among family caregivers of incurable cancer patients in two eastern Mediterranean countries

Background Although family caregivers (FCs) play an important role in the care provided to incurable cancer patients in our region, little is known about the burden they experience. This study was conducted to determine the prevalence of caregiver burden (CB) among FCs of incurable cancer patients in two Eastern Mediterranean countries and to identify factors that may be associated with significant CB. Methods The study included 218 FCs, 165 from Egypt and 53 from Saudi Arabia. The 22-item Zarit Burden Interview (ZBI-22) was used to assess caregiver burden CB. Significant CB was defined as a ZBI-22 score ≥ 21. The assistance with basic ADLs was classified into 3 levels according to FCs’ assistance with early/middle/late-loss basic ADLs. The relationship between CB and the assistance with ADLs and other factors was studied. Results The mean (SD) ZBI-22 score among FCs was 23.4 (9.3) and the majority (128/218, 59%) had significant CB. Eighty-nine percent of FCs assisted with at least one basic ADL. Assistance with late-loss basic ADLs, best supportive care treatment plan and poorer performance status were associated with higher CB (p < 0.0001, =0.018 and = 0.005). However, in logistic regression analysis, only assistance with late-loss ADLs was independently associated with significant CB (OR = 3.4 [95%CI:1.2–9.7], p = 0.024). Conclusion A substantial proportion of FCs of incurable cancer patients in our region experience significant CB. Family caregivers assisting with late-loss basic ADLs are at risk of significant CB and should be routinely screened for CB.

Microbiological findings in early and late implant loss: an observational clinical case-controlled study

Background Implants are a predictable and well-established treatment method in dentistry. Nevertheless, looking at possible failures of dental implants, early and late loss have to be distinguished. The intent of the study was to report microbiological findings on the surface of implants with severe peri-implantitis, which had to be explanted. Methods 53 specimens of implants from 48 patients without severe general illnesses have been examined. The groups investigated were implants that had to be removed in the period of osseointegration (early loss, 13 patients with 14 implants) or after the healing period (late loss, 14 patients with 17 implants). The implant losses were compared with two control groups (implants with no bone loss directly after completed osseointegration, two to four months after implant placement (17 patients with 17 implants) and implants with no bone loss and prosthetic restoration for more than three years (5 patients with 5 implants)). Data about the bacteria located in the peri-implant sulcus was collected using amplification and high throughput sequencing of the 16S rRNA gene. Results The biofilm composition differed substantially between individuals. Both in early and late implant loss, Fusobacterium nucleatum and Porphyromonas gingivalis were found to be abundant. Late lost implants showed higher bacterial diversity and in addition higher abundances of Treponema, Fretibacterium, Pseudoramibacter and Desulfobulbus, while microbial communities of early loss implants were very heterogeneous and showed no significantly more abundant bacterial taxa. Conclusions Specific peri-implant pathogens were found around implants that were lost after a primarily uneventful osseointegration. P. gingivalis and F. nucleatum frequently colonized the implant in early and late losses and could therefore be characteristic for implant loss in general. In general, early lost implants showed also lower microbial diversity than late losses. However, the microbial results were not indicative of the causes of early and late losses.

Microbiological findings in early and late implant loss: an observational clinical case-controlled study

Background Implants are a predictable and well-established treatment method in dentistry. Nevertheless, looking at possible failures of dental implants, early and late loss have to be distinguished. The intent of the study was to report microbiological findings on the surface of implants with severe peri-implantitis, which had to be explanted. Methods 53 specimens of implants from 48 patients without severe general illnesses have been examined. The groups investigated were implants that had to be removed in the period of osseointegration (early loss, 13 patients with 14 implants) or after the healing period (late loss, 14 patients with 17 implants). The implant losses were compared with two control groups (implants with no bone loss directly after completed osseointegration, two to four months after implant placement (17 patients with 17 implants) and implants with no bone loss and prosthetic restoration for more than three years (5 patients with 5 implants)). Data about the bacteria located in the peri-implant sulcus was collected using amplification and high throughput sequencing of the 16S rRNA gene. Results The biofilm composition differed substantially between individuals. Both in early and late implant loss of Fusobacterium nucleatum , and Porphyromonas gingivalis were found to be abundant . Late lost implants showed higher bacterial diversity and in addition higher abundances of Treponema, Fretibacterium, Pseudoramibacter and Desulfobulbus , while microbial communities of early loss implants were very heterogeneous and showed no significantly more abundant bacterial taxa. Conclusions Specific peri-implant pathogens were found around implants that were lost after a primarily uneventful osseointegration. P. gingivalis and F. nulceatum frequently colonized the implant in early and late losses and could therefore be characteristic for implant loss in general. In general, early lost implants showed also lower microbial diversity than late losses. However, the microbial results were not indicative of the causes of early and late losses.

Microbiological findings in early and late implant loss: an observational clinical cohort study

BackgroundImplants are a predictable and well-established treatment method in dentistry. Nevertheless, early and late loss must be distinguished when examining possible failures of dental implants. The aim of the study was to report microbiological findings on the surface of implants with severe peri-implantitis, which had to be explanted.MethodsFifty-three specimens of implants from 48 patients without severe general illnesses were examined. The groups investigated were implants that had to be removed in the period of osseointegration (early loss, 13 patients with 14 implants) or after the healing period (late loss, 14 patients with 17 implants). Implant losses were compared with two control groups (implants with no bone loss directly after complete osseointegration, two to four months after implant placement (17 patients with 17 implants) and implants with no bone loss and prosthetic restoration for more than three years (5 patients with 5 implants)). Data for the bacteria located in the peri-implant sulcus were collected using amplification and high-throughput sequencing of the 16S rRNA gene.ResultsThe biofilm composition differed substantially between individuals. In both early and late implant loss, Fusobacterium nucleatum and Porphyromonas gingivalis were found to be abundant. Late-loss implants showed higher bacterial diversity and higher abundances of Treponema, Fretibacterium, Pseudoramibacter and Desulfobulbus, while microbial communities of early-loss implants were very heterogeneous and showed no significantly more abundant bacterial taxa.ConclusionsSpecific peri-implant pathogens were found around implants that were lost after a primarily uneventful osseointegration. P. gingivalis and F. nucleatum frequently colonized the implant in early and late losses and may therefore be a general characteristic of implant loss. The reasons for early losses seem to be multifactorial, with bacterial infection being one potential risk factor, while peri-implant infections are known to be a major risk among other aspects, such as overload or mechanical complications.

Clinical impact of triglyceride deposit cardiomyovasculopathy, coronary atherosclerosis with triglyceride deposition, on vascular failure after drug-eluting stent implantation

Background Triglyceride deposit cardiomyovasculopathy (TGCV) is a novel cardiovascular disorder, encoded as orphan disease in Europe in 2019, characterized by excessive accumulation of triglyceride in vascular smooth muscle cells, leading to coronary artery disease (CAD). However, there is no data about impact of TGCV on vascular failure after coronary stent implantation. Purpose To assess impact of TGCV on the outcome following coronary stent implantation in CAD patients with diabetes mellitus (DM) as Study 1, and chronic hemodialysis as Study 2. Methods This is multicenter retrospective estimation consisting of two studies. Study 1) Among 526 consecutive patients suspected of having CAD who underwent coronary angiography (CAG) and iodine-123-β-methyliodophenyl-pentadecanoic acid (BMIPP) scintigraphy, a tracer for the diagnosis of TGCV, data from 81 patients with DM were analyzed. The patients were divided into two groups; TGCV (n=7) or non-TGCV (n=74). All patients were implanted with a second-generation DES and underwent follow-up CAG. Binary restenosis (ISR), defined as angiographic luminal diameter &gt;50% by quantitative coronary angiography, in-stent late loss were assessed in 15 stents of TGCV patients and 111 stents of non-TGCV patients. Study 2) Similarly, among 88 chronic hemodialysis patients, ISR and in-stent late loss were assessed in 12 stents of 9 TGCV patients and 21 stents of 17 non-TGCV patients. Results Study 1) There were no significant differences in baseline characteristics between the two groups. In-stent late loss was greater in TGCV group than in non-TGCV group (0.91mm [0.27, 2.39] vs. 0.15mm [0.03, 0.35]; p&lt;0.001), resulting in greater incidence of ISR in TGCV group than in non-TGCV group (46.7% vs. 9.0%; p&lt;0.001). Multivariable logistic analysis revealed TGCV to be an independent predictor for vascular failure after DES implantation in patients with DM. Study 2) Similarly, in-stent late loss and incidence of ISR were greater in TGCV group than in non-TGCV group (1.20±0.99mm vs. 0.50±0.70, p=0.02; 58.3% vs. 9.5%, p=0.002, respectively). TGCV was an independent predictor for vascular failure after DES implantation in chronic hemodialysis patients. Conclusion Apart from existing risk factors such as DM and hemodialysis, TGCV could contribute to a novel risk factor for vascular failure, even in the second-generation DES era. Figure 1 Funding Acknowledgement Type of funding source: None

Microbiological Findings in Early and Late Implant Loss

Background Implants are a predictable and well-established treatment method in dentistry. Nevertheless, looking at possible failures of dental implants, early and late loss have to be distinguished. This study aimed at microbiological aspects on surfaces of implants, which had to be removed.Methods 53 specimens of implants from 49 healthy patients have been examined. The groups investigated were implants that had to be removed in the period of osseointegration (early loss) or after the healing period (late loss). Data about the microbiological colonialization of the implant was collected using amplification and high throughput sequencing of the 16S rRNA gene.Results Both early and late implant loss was associated with increased levels of Fusobacterium nucleatum and Porphyromonas gingivalis. Additionally. Late lost implants showed higher bacterial diversity and in addition higher abundances of Treponema denticola and Tannerella forsythia, while microbial communities of early loss implants were very heterogeneous.Conclusions Pathogens commonly associated with severe periodontitis were found around implants that were lost after a primarily uneventful osseointegration. P. gingivalis and F. nucleatum colonized the implant surface in early and late loss and could therefore be characteristic for implant loss in general. The reasons for early losses could be multifactorial. Trial registration This study was approved by the ethical review committee of the local medical association (Institutional Review Board of the Saarland Medical Council, Germany; ID: 232/12).

The Bidirectional Relationship Between Cognitive Function and Loss Hierarchy of Activities of Daily Living Among Older Adults with Disabilities in China: A Cross-Lagged Analysis

Background The Chinese population is experiencing rapid aging, limitations in activities of daily living and decline in cognitive function among the oldest-old group causes tremendous economic, family and social burden. Examining their relationship is critically relevant for policymakers. The present study aimed to determine the bidirectional relationship between cognitive function and the loss hierarchy of activities of daily living among older adults in China. Methods Data were derived from a sample of 469 older adults who participated in both the 2010 and 2013 waves of a Longitudinal Study on Family Caregivers for Frail Older Adults. Cognitive function was assessed using the Chinese version of the Short Portable Mental Status Questionnaire and activities of daily living were measured by self-reports of having difficulty or needing help with basic daily activities. A cross-lagged analysis was adopted. Results In general, the results showed cognitive function in 2010 was a significant predictor of middle loss activities of daily living (dressing, moving, bathing and toileting) in 2013, and late loss activities of daily living (feeding and hygiene) in 2013. The loss hierarchy of activities of daily living among older adults was not shown to be significant as a risk factor of cognitive function in 2013. Conclusions The findings expanded understanding of the relationship between cognitive function and the loss hierarchy of activities of daily living as well as provided evidence for clinicians and service planners for anticipating the subsequent care and service needs of the elderly and their families.

Dialysis after graft loss: a Swiss experience

Background Patients returning to dialysis after graft loss have high early morbidity and mortality. Methods We used data from the Swiss Transplant Cohort Study to describe the current practice and outcomes in Switzerland. All patients who received a renal allograft between May 2008 and December 2014 were included. The patients with graft loss were divided into two groups depending on whether the graft loss occurred within 1 year after transplantation (early graft loss group) or later (late graft loss group). Patients with primary non-function who never gained graft function were excluded. Results Seventy-seven out of 1502 patients lost their graft during follow-up, 40 within 1 year after transplantation. Eleven patients died within 30 days after allograft loss. Patient survival was 86, 81 and 74% at 30, 90 and 365 days after graft loss, respectively. About 92% started haemodialysis, 62% with definitive vascular access, which was associated with decreased mortality (hazard ratio = 0.28). At the time of graft loss, most patients were on triple immunosuppressive therapy with significant reduction after nephrectomy. One year after graft loss, 77.5% (31 of 40) of patients in the early and 43.2% (16 out of 37) in the late-loss group had undergone nephrectomy. Three years after graft loss, 36% of the patients with early and 12% with late graft loss received another allograft. Conclusion In summary, our data illustrate high mortality, and a high number of allograft nephrectomies and re-transplantations. Patients commencing haemodialysis with a catheter had significantly higher mortality than patients with definitive access. The role of immunosuppression reduction and allograft nephrectomy as interdependent factors for mortality and re-transplantation needs further evaluation.

Inter- and intra-core laboratory variability in the quantitative coronary angiography analysis for drug-eluting stent treatment and follow up

Aim: To evaluate inter-core laboratory variability of quantitative coronary angiography (QCA) parameters in comparison with intra-core laboratory variability in a randomized controlled trial evaluating drug-eluting stents. Methods: A total of 50 patients with 62 coronary lesions were analyzed by four analysis experts belonging to an Angiographic Core Laboratory (ACL: 1 expert) and a Cardiovascular Imaging Core Laboratory (CICL: 3 experts). QCA was based on the same standard operating procedure, but selections of projection and cine frames were at the discretion of each analyst. Inter- and intra-core laboratory variabilities were evaluated by accuracy, precision, Bland Altman analysis, and coefficient of variation. Results: Pre-MLD (minimal lumen diameter) was significantly smaller in results from ACL than those from all CICL experts. Number of analyzed projections did not affect pre-MLD results. Acute gain was larger in ACL than in CICL2. No significant difference was observed in late loss and loss index between inter-core laboratories. Agreement between core labs in the Bland-Altman analysis for each QCA parameter was as follows (mean difference, 95% limits of agreement): pre-MLD (–0.32, –0.74 to 0.10), stent MLD (0.08, –0.28 to 0.44), acute gain (0.22, –0.44 to 0.88), and late loss (–0.07, –0.69 to 0.55). Agreement between analysts in CICL (mean difference, 95% limits of agreement) was: pre MLD (–0.03, –0.37 to 0.31), stent MLD (0.15, –0.15 to 0.45), acute gain (0.05, –0.45 to 0.55), and late loss (0.04, –0.52 to 0.60). The widest limits of agreement among three analyses were shown in both analyses. Width of limited agreement in the intra-core laboratory analysis tended to be smaller than the inter-core laboratory analysis with these parameters. Coefficient of variation tended to be larger in lesion length (LL), acute gain, late loss, and loss index in inter- and in intra- core laboratory comparisons. Conclusion: Inter-core laboratory QCA variability in late loss and loss index analysis could be similar to intra-core laboratory variability, but more strict alignment between core laboratories would be necessary for initial procedural data analysis.

Analysis of the Survival of Dental Implants Installed in Reconstructed Maxilla with Autogenous Iliac Crest Graft: 7- to 9-Year Follow-Up

The aim of this study was to analyze the survival of dental implants installed in maxillae reconstructed with autogenous iliac crest grafts and to assess patient satisfaction with the treatment by means of a questionnaire. The study conducted medical record reviews and clinical/radiographic assessments of 10 patients with severe maxillary atrophy who had undergone reconstruction with autogenous iliac crest grafts and rehabilitation with dental implants between 2008 and 2011. Patients were assessed for the survival of the implants, considering implant diameter and length, smoking status, diagnosis of diabetes, type of loss, and region of implant loss. In addition, a questionnaire with specific questions on the patients' satisfaction with the treatment was administered. Seventy-six implants were installed in the sampled patients, and only 1 loss was observed (late loss in the anterior maxilla region) after an average follow-up of 7.9 years, which corresponds to a 98.60% survival rate. The installed implants were of the most frequently used dimension (3.75 × 10 mm). One sampled patient was diabetic, and a second patient was both diabetic and a smoker. No loss of implants was observed in these 2 patients. All patients reported being completely satisfied with the treatment and would undergo the procedure again or refer it to a friend/relative. Six patients reported regular maintenance of the prosthesis, and only 3 had changed the prosthesis prior to the time of questionnaire administration. The results of this limited study with a restricted sample population suggest that the reconstruction of the maxilla with an autogenous iliac crest graft provides both adequate implant survival and patient satisfaction.