Multiparameter Monitoring with a Wearable Cardioverter Defibrillator

A wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) and for patients who are temporarily not candidates for an implantable cardioverter defibrillator (ICD). In addition, the need for telemedical concepts in the detection and treatment of heart failure (HF) and its arrhythmias is growing. The WCD has evolved from a shock device detecting malignant ventricular arrhythmias (VA) and treating them with shocks to a heart-failure-monitoring device that captures physical activity and cardioacoustic biomarkers as surrogate parameters for HF to help the treating physician surveil and guide the HF therapy of each individual patient. In addition to its important role in preventing SCD, the WCD could become an important tool in heart failure treatment by helping prevent HF events by detecting imminent decompensation via remote monitoring and monitoring therapy success.

Temporary adhesive bridge restoration of the upper anterior teeth lost due to trauma: Three case reports

Aim: Traumatic dental injuries at the anterior region of the maxilla occur frequently in children and adults. In this case report, we aimed to describe the temporary aesthetic restoration of the upper lateral incisor with a fiber-reinforced bridge by using the original tooth crown, which had avulsed after dental trauma. Methodology: Case 1: A 14-year-old girl with an avulsion in tooth #11 due to trauma visited our clinic. During the examination, it was seen that the wound had healed, and there was no luxation in teeth #21 and #12. Since the patient could not undergo prosthetic procedures, for reasons including implants, and did not want a removable prosthesis, a single crown supported by acrylic tooth fibers was constructed. Case 2: A 17-year-old male patient was referred to our clinic because of an avulsed left lateral incisor tooth, which was traumatized 15 days before visiting the clinic. His medical history revealed that his parents had found the tooth two hours after the trauma. However, the emergency clinic that he had previously visited did reimplant that tooth and repaired it with fiber-reinforced composite. Case 3: In the examination of a 12-year-old male patient who applied to our clinic due to trauma, it was observed that tooth #11 had an avulsion and tooth #12 had a crown fracture. Root canal treatment was performed. A crown was made for the patient by supporting the fiber inside the canals of tooth #11 and tooth #21. It was revised aesthetically with the support of the crown of the other tooth. Conclusion: Avulsion after anterior trauma affects patients’ appearance aesthetically; thus, patients want to be treated as soon as possible. Function, phonation, and aesthetics must be quickly provided for a loose anterior tooth. Fiber-reinforced adhesive bridge techniques may be considered as a temporary treatment for providing an aesthetically appealing appearance until the completion of permanent prosthetic treatment. How to cite this article: Şahin M, Toptancı İR. Temporary adhesive bridge restoration of the upper anterior teeth lost due to trauma: Three case reports. Int Dent Res 2021;11(Suppl.1):285-91. https://doi.org/10.5577/intdentres.2021.vol11.suppl1.42 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

3D Printing of Polyamide to Fabricate a Non-Metal Clasp Removable Partial Denture via Fused Filament Fabrication: A Case Report

The fabrication of a non-metal clasp removable partial denture (RPD) using polymethylmethacrylate in a fully digital workflow has been reported. According to some studies, the polyamide material may be alternatively used for this purpose. The authors are unaware of any reports concerning the additive manufacturing of polyamide. The current proof-of-concept dental technique describes the pathway to construct the non-metal clasp RPD using intraoral scanning and fused filament fabrication (FFF) printing of gingiva-colored polyamide. The present RPD showed acceptable fit and sufficient retention and was considered a valid temporary treatment option.

A case report of cardiac toxicity from barracuda ingestion in Mexico

Background Ciguatera toxicity is a fish-borne illness that initially manifests with gastrointestinal symptoms, followed by bizarre neurological symptoms including heat-cold sensation alteration, peculiar feeling of loose teeth, and peripheral neuropathy. However, cardiac manifestations are rare and underreported in the literature. Case summary A 73-year-old man presented with symptomatic bradycardia and hypotension after ingestion of barracuda fish in Mexico. He received atropine and dopamine with subsequent improvement in his symptoms, but continued to experience peripheral neuropathic and other odd sensations. Four of his family members ingested the same fish and had similar symptoms. He was managed conservatively and did not require temporary or permanent pacing. Within 1 week from toxin exposure, bradycardia had improved. Heart rate was 40–50 b.p.m. at rest, and he was discharged with an ambulatory monitor. Heart rate had increased to 77 b.p.m. at 1-month follow-up on repeat electrocardiogram (ECG). Discussion Although the predominant manifestations of ciguatera toxicity are neurological, cardiac complications tend to be more acute and require attention. Unlike neurological symptoms, bradycardia and hypotension are short-lived, often resolving within a week. Treatment continues to be largely supportive, and patients may require temporary treatment with positive chronotropic agents such as atropine or dopamine.

Clinician and Patient Factors Influencing Treatment Decisions: Ethnographic Study of Antibiotic Prescribing and Operative Procedures in Out-of-Hours and General Dental Practices

Operative treatment is indicated for most toothache/dental abscesses, yet antibiotics instead of procedures are often prescribed. This ethnographic study aimed to identify clinician and patient factors influencing urgent dental care for adults during actual appointments; and to identify elements sensitive to context. Appointments were observed in out-of-hours and general dental practices. Follow-up interviews took place with dentists, dental nurses, and patients. Dentist and patient factors were identified through thematic analysis of observation records and appointment/interview transcripts. Dentist factors were based on a published list of factors influencing antibiotic prescribing for adults with acute conditions across primary health care and presented within the Capability-Opportunity-Motivation-Behaviour model. Contextually sensitive elements were revealed by comparing the factors between settings. In total, thirty-one dentist factors and nineteen patient factors were identified. Beliefs about antibiotics, goals for the appointment and access to dental services were important for both dentists and patients. Dentist factors included beliefs about the lifetime impact of urgent dental procedures on patients. Patient factors included their communication and negotiation skills. Contextual elements included dentists’ concerns about inflicting pain on regular patients in general dental practice; and patients’ difficulties accessing care to complete temporary treatment provided out of hours. This improved understanding of factors influencing shared decisions about treatments presents significant opportunity for new, evidence-based, contextually sensitive antibiotic stewardship interventions.

917Appropriate shocks in WCD patients - Results from the Austrian WCD registry

Background The wearable cardioverter-defibrillator (WCD) is a temporary treatment option for patients at high risk for sudden cardiac death (SCD) and/or for patients in whom implantation of a cardioverter defibrillator (ICD) is temporarily not possible. Purpose To investigate incidence and predictors of appropriate WCD shocks. Methods We performed a retrospective analysis of all patients with appropriate shocks delivered by a WCD in the cohort of the Austrian WCD registry between 2010 and 2018. Within this dataset, we identified predictors within the baseline characteristics, the indication for the WCD and preceding alarms automatically recorded by the WCD. Results: Baseline Within 879 registered in the Austrian WCD registry, 31 patients (3,5%) received appropriate WCD shocks due to ventricular tachycardia (VT) or ventricular fibrillation (VF). Compared to the total cohort, shocked patients were elder (mean age 67 ± 14 vs. 60 ± 14 years, p = 0,001) and the percentage of female patients was lower (11% vs. 21%, p = 0,262). The mean baseline LVEF at prescription was 33 ± 15% in the population with appropriate shocks compared to 32 ± 14% in the all-over cohort (p = ns). In the Austrian WCD population, 378/879 patients had a WCD due to secondary prevention. Within this cohort 5,6% (21/378) had shocks for VT/VF again, compared to 10/501 (2%) shocked patients in the primary prevention cohort. 31/879 (3.5%) patients received 57 appropriate shocks, the per patient shock rate was 2 [1;5]. These shocks were induced by 25 ventricular tachycardia and 26 times ventricular fibrillation. The octagenarians with 11% (7/34) shocked patients, showed a significant higher likelihood to receive shocks (p = 0,008) as well as the cohort of secondary preventive prescribed WCD-patients (p = 0,007). There were more shocks in patients, when prescribed with a WCD due to ICD associated infections (p = 0,001), when used as a bridge to ICD (p = 0,042) and in patients with ongoing risk stratification (p = 0,009). Looking through the automatically recorded alarms preceding a WCD shock, shocked patients experienced significantly more often non sustained VTs (p < 0,0005) and sustained VTs that were haemodynamically tolerated and did not require a treatment (p < 0,0005). Conclusion The WCD is effective in preventing SCD and an important risk stratification tool. We identified advanced age, patients with either already confirmed indication for ICD implantation (either temporary contraindication for implantation or temporary explantation) or risk stratification of an unclear cardiomyopathy, the cohort of secondary prevention and preceding nsVTs and stable VTs as predictors for appropriate WCD therapies.

SEVERE RADIODERMATITIS AND RISK FACTORS ASSOCIATED IN HEAD AND NECK CANCER PATIENTS

ABSTRACT Objective: To evaluate the association between sociodemographic, clinical, and treatment factors in the outcome of severe radiodermatitis in patients with head and neck cancer seen at the nursing consultation; and to analyze the impact of severe radiodermatitis cases on therapeutic follow-up. Method: A quantitative, documentary research conducted with medical records of 167 patients with head and neck cancer submitted to radiotherapy with curative indication followed in the nursing consultation in 2016. A structured form was used for data collection and analytical and descriptive statistics were used for its analysis. Results: Of the 99.4% patients who had radiodermatitis, 11.4% were severe cases. Severe radiodermatitis was associated with the type of equipment, treatment technique and presence of comorbidities. Of the patients who presented grade three, 53% had temporary discontinuation of treatment. Conclusion: Head and neck cancer patients who undergo radiotherapy with curative indication are at risk for severe radiodermatitis. Nursing consultation is important to minimize the severity of this event and the reduction of temporary treatment interruption due to this adverse reaction.

Value of stereoelectroencephalography (SEEG)-guided radiofrequency thermocoagulation in treating drug-resistant focal epilepsy

Stereoelectroencephalography (SEEG) has been widely used in the presurgical evaluation of patients with medically intractable epilepsy. In the past, SEEG was commonly used as a method for mapping and localizing the epileptogenic zone (EZ). Since 2004, several studies have been conducted to examine the effectiveness of SEEG-guided radiofrequency thermocoagulation (RF-TC) in treating refractory epilepsy. However, the seizure-free and responder rates varied greatly across studies. We aimed to analyze the outcome of 56 patients who were treated with SEEG-guided RF-TC to evaluate the effectiveness of this treatment. SEEG-guided RF-TC can be considered as a treatment for refractory epilepsy. However, due to its limited efficacy, SEEG-guided RF-TC might be regarded as a temporary treatment performed under SEEG rather than a promising treatment for refractory epilepsy.