Τετάρτη, 1 Μαΐου 2019

Oncology Nursing

Active Smoking at the Time of A Lung Cancer Diagnosis
Rebecca H Lehto

Asia-Pacific Journal of Oncology Nursing 2019 6(3):207-208



Factors in Cancer-Related Fatigue Self-Management Behaviors of Outpatients Undergoing Chemotherapy
Ikuko Chiba, Tomoyo Sasahara, Michiyo Mizuno

Asia-Pacific Journal of Oncology Nursing 2019 6(3):209-211



Adverse Events of Oncologic Immunotherapy and Their Management
Fedricker Diane Barber

Asia-Pacific Journal of Oncology Nursing 2019 6(3):212-226

Over the past two decades, immunotherapy has emerged as a promising treatment option for patients with cancer. However, newer versions of immunotherapy, such as checkpoint inhibitors, may be associated with unusual adverse effects (AEs) that can range in severity from mild to life-threatening. Unlike common AEs of conventional chemotherapy, which have a predictable nadir or cyclic pattern after administration, AEs of these newer immunotherapies are variable, depending on the type of immunotherapy, route of administration, and mechanism of action. The onset and resolution of these AEs may be present at any time, during administration of treatment, a few weeks after administration of treatment, or several months after completion of treatment. Therefore, improving outcomes in patients undergoing oncologic immunotherapy requires oncology nurses' knowledge and understanding of various immunotherapy agents, as well as early recognition and management of potential AEs, especially AEs associated with checkpoint inhibitors and other therapies that manipulate T-cell activation causing autoimmune toxicity. This article draws upon current evidence from systematic reviews, meta-analyses, and expert consensus guidelines to provide a brief overview of common immunotherapies used in cancer and management of their associated AEs. 


Evaluation of the True Endpoint of Clinical Trials for Cancer Cachexia
Tateaki Naito

Asia-Pacific Journal of Oncology Nursing 2019 6(3):227-233

Cachexia is an old disease but a new research area that has recently been vigorously investigated. The diagnostic and staging criteria for cancer-associated cachexia have been established through an international consensus report (CR) published in 2011, which may greatly influence the designs and interventions of future clinical trials. However, no standard treatment has been established so far. This may be partially due to the lack of a widely accepted common endpoint for clinical trials. This review aimed to summarize designs and endpoints of 65 randomized controlled trials for cancer cachexia in the past 16 years and seek clinically relevant patient-centered outcomes for future clinical trials. Compared with trials before the CR, trials after the report revealed that the study populations tended to be at the earlier stage of cachexia and included patients with precachexia or those at risk for cachexia. Nonpharmacological interventions have been widely tested, and functional endpoints have increasingly been selected in combination with standard endpoints of body mass or lean body mass. Disability-free survival has recently been used as a functional endpoint in clinical trials in several research fields. It might be also a suitable patient-centered outcome responsive to multiple physical changes in cancer cachexia, and patients might find it more acceptable than other classical endpoints. More efforts would be needed to identify an optimal measurable endpoint and establish a better combination of pharmacological and nonpharmacological interventions to improve the functional prognosis for patients with cancer cachexia. 


Utilizing the Advances in Digital Health Solutions to Manage Care in Cancer Patients
Andreas Charalambous

Asia-Pacific Journal of Oncology Nursing 2019 6(3):234-237

In recent years, the clinical context for cancer has changed, and it is now characterized by extended survival rates and more diverse and complex cancer trajectories and symptomatology. The changes in the landscape of cancer care also include a shift towards the home setting or the outpatient setting with an increased amount of care being delivered at home or transferred to the patients themselves and their family caregivers. These changes have also impacted the type and amount of information required by the patients and their caregivers as well as the type of care needs that are to be addressed by health-care professionals. Finally, the transitions within the health-care setting might also create a caring gap that the patient is left to deal with independently or with minimal support. These changes have led to the emergence of innovative digital/technological solutions for supporting patients during their cancer care continuum. 


Radiation Fibrosis Syndrome: The Evergreen Menace of Radiation Therapy
Abhishek Purkayastha, Neelam Sharma, Arti Sarin, Sharad Bhatnagar, Nilotpal Chakravarty, Hari Mukundan, Virender Suhag, Sankalp Singh

Asia-Pacific Journal of Oncology Nursing 2019 6(3):238-245

Fibrosis is a descriptive appellation referring to the obliteration of normal tissue components replaced by matrix and disorganized and varied collagen fibrils that result in the loss of organ function and frequent tissue contraction leading to death or significant deterioration in the quality of life. Radiation fibrosis syndrome (RFS) is a progressive fibrotic tissue sclerosis with various clinical symptoms in the irradiation field. It is usually a late complication of radiation therapy and may occur weeks or even years after treatment. It may affect the musculoskeletal, soft tissue, neural tissue, and cardiopulmonary systems. RFS is a serious and lifelong disorder that, nevertheless, may often be prevented when identified and rehabilitated early. Genetic factors likely play a significant role in the development of chronic fibrotic response to radiation injury that persists even after the initial insult is no longer present. Management of this syndrome is a complex process comprising medication, education, rehabilitation, and physical and occupational therapy. A bibliographical search was carried out in PubMed using the following keywords: “radiation fibrosis,” “radiation fibrosis syndrome,” and “radiation-induced fibrosis.” We also reviewed the most relevant and recent series on the current management of RFS, and the reviewed data are discussed in this article. This review discusses the pathophysiology, evaluation, and treatment of neuromuscular, musculoskeletal, and functional disorders as late effects of radiation treatment. 


Medication Safety: A Need to Relook at Double-Checking Medicines?
Gek Phin Chua, Kim Hua Lee, Gemma Diente Peralta, John Heng Chi Lim

Asia-Pacific Journal of Oncology Nursing 2019 6(3):246-252

Objective: To present a structured evaluation process that provides evidence that the single-checking (SC) system is not only a viable option in reducing medication errors, but also has the added advantage of increasing staff satisfaction. Methods: The structured evaluation involved one work improvement process and conducting a survey establishing registered nurses' (RNs') attitude toward SC of medicines. The survey questionnaire included 12 questions with a 5-point Likert scale. Results: In spite of the increased number of patients, the number of medication errors actually reduced (P < 0.001; two-sample test of proportions) with the implementation of SC of medication for competent and experienced staff. A survey was conducted to establish RNs' attitudes toward SC of medicines 3 years post SC implementation. RNs viewed the single-nurse checking protocol positively. In particular, the nurses considered single-nurse checking as an encouragement to update their drug knowledge and as a time-saving measure, enhancing the quality of patient care. Nonetheless, they also expressed concerns on single-nurse checking. Conclusions: The findings provide evidence that SC system is a viable way to reducing medication errors and also confer the added advantage of staff satisfaction. Assuring quality and safety involves the need to challenge the status quo based on revealed evidence. 


Falls and Functional Impairments in Breast Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy
Hiroko Komatsu, Kaori Yagasaki, Yasuhiro Komatsu, Hideko Yamauchi, Teruo Yamauchi, Toshio Shimokawa, Ardith Z Doorenbos

Asia-Pacific Journal of Oncology Nursing 2019 6(3):253-260

Objective: We investigated the incidence of falls and functional impairments in breast cancer patients with chemotherapy-induced peripheral neuropathy (CIPN). Additionally, we examined whether taxane-induced peripheral neuropathy was associated with the patients' falls and functional impairments. Methods: We conducted a cross-sectional study including 88 patients with breast cancer who received taxane-based chemotherapy and were recognized as having peripheral neuropathy symptoms (Common Terminology Criteria for Adverse Events Grade ≥1). Patients completed the Functional Assessment of Cancer Therapy-Gynecologic Oncology Group-Neurotoxicity questionnaire for neuropathy and described falls from the onset of the taxane-based chemotherapy to the time of the survey. Functional impairments were defined using the Activities of Daily Living subsection of the Vulnerable Elder's Scale. Data were analyzed using descriptive statistics and logistic regression. Results: Of the participants, 40.9% experienced falls and 38.4% reported functional impairments. Most falls occurred on flat ground. Bone fracture due to falls was observed in 11.4% of the participants. Logistic regression revealed that CIPN was not significantly associated with the reported incidence of falls. However, it was significantly associated with functional impairments (odds ratio, 6.415; 95% confidence interval: 1.271–32.379; P = 0.024). Conclusions: CIPN was associated with functional impairments, but not with the incidence of falls. Patients should be informed prior to the onset of anticancer therapy that CIPN is a risk factor for functional impairments. 


Emotional Intelligence as A Predictor of Health-Related Quality of Life in Breast Cancer Survivors
Sahar Mirzaei, Ahmad Izadi Tame, Robab Anbiaie, Fateme Moradipour, Malihe Nasiri, Camelia Rohani

Asia-Pacific Journal of Oncology Nursing 2019 6(3):261-268

Objective: The objective of this study is to explore the predictive role of emotional intelligence (EI) and its elements for health-related quality of life (HRQoL) dimensions in a sample of breast cancer survivors. Methods: This cross-sectional study was conducted in a single oncology clinic at a university hospital. A sample of breast cancer survivors (n = 180) completed three questionnaires: Short-Form Health Survey SF-36 (the RAND 36-item) with 8 dimensions; Cyberia Shrink EI Test (with five elements); and demographic Characteristics. The data were analyzed using SPSS version 20 (IBM Corporation, Armonk, NY, USA). A series of multiple linear regression models were used to analyze the data. Results: EI was a predictor for two dimensions of HRQoL components in survivors: mental (β = 0.45, P < 0.001); and physical (β = 0.27, P < 0.001). However, it was a better predictor for the mental HRQoL than for physical. More specifically, several elements of EI, including self-motivation, self-awareness, and self-control, demonstrated significant variance with a medium effect for prediction of dimensions of HRQoL. “Self-motivation” (β = 0.27, P < 0.001) and “self-awareness” (β = 0.29, P < 0.01) together were the best predictors of the variances of survivors' “general health” (R2 = 28%). “Self-motivation” (β = 0.39, P < 0.001), and “self-control” (β = 0.19, P < 0.05), also together, were the best predictors of the variances of survivors' “emotional well-being” (R2 = 28%). Conclusions: Educational intervention programs should be planned by concentrating on special elements of EI, including self-motivation, self-awareness and self-control, to improve HRQoL dimensions in breast cancer survivors. 


Toward A Germinal Theory of Knowing-Revealing-Humanizing as Expressions of Caring in Cancer Palliative Care
Chinomso Ugochukwu Nwozichi

Asia-Pacific Journal of Oncology Nursing 2019 6(3):269-276

Objective: Survival chances of people with cancer in Nigeria are far worse than those in developed countries. While the chance of finding a lasting solution to cancer in Nigeria is remote, patients living with cancer still need treatment regardless of the terminal outcome, and hence cancer palliative care is necessitated. Caring patterns and expressions differ in diverse contexts. Therefore, this article aimed to present the meanings and expectations of caring and the resulting transformative theory of practice. Methods: A descriptive, qualitative inquiry was conducted with a purposive sample of 12 cancer palliative patients, 9 nurses, 3 physicians, and 5 relatives who were approached for an in-depth interview about their conceived meanings and expectations of caring for or being cared for in the cancer palliative unit. Results: Cancer palliative care in Nigeria is best exemplified through the processes/themes of “knowing,” “revealing,” and “humanizing.” The meaning of care and the expectations of the patients and caregivers were grouped into these three overarching processes which then informed the conceptualization of a germinal theory of knowing-revealing-humanizing (TKRH) as expressions of caring in cancer palliative care. Conclusions: The application of the KRH practice processes is illustrated as a transformative germinal theory of practice. This TKRH as expressions of caring is transformative and can restore positive meanings in the life-world of persons in the cancer palliative care setting. 


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Oral Oncology

  1. Myoepithelial carcinoma with rhabdoid features in the maxillary sinus: Immunohistochemical and in situ hybridization analysis of a rare case

    In Press, Corrected Proof, Available online 30 April 2019
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    Abstract

    Myoepithelial carcinomas of the head and neck are often located in the major salivary glands, notably in the parotid glands, being less frequent in the minor salivary glands. Noteworthy, myoepithelial carcinoma in the maxillary sinus is extremely rare. In fact, only five cases have been previously published to date. Here, we present, for the first time, a detailed immunohistochemical and in situ hybridization analysis of a SMARCB1 (INI-1)-intact myoepithelial carcinoma with rhabdoid features, expanding the histopathological spectrum of high-grade sinonasal carcinomas.

  2. Corrigendum to "Utility of CD8 score by automated quantitative image analysis in head and neck squamous cell carcinoma" [Oral Oncol. 86 (2018) 278–287]

    In Press, Corrected Proof, Available online 30 April 2019
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  3. Regression and long-term control after radiotherapy of carotid body paraganglioma – Are these still issues?

    In Press, Corrected Proof, Available online 30 April 2019
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  4. Concurrent oropharyngeal squamous cell carcinomas in couples

    In Press, Corrected Proof, Available online 25 April 2019
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  5. Tooth mobility: A plausible predictor of bony margins

    In Press, Corrected Proof, Available online 24 April 2019
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  6. Sanctuary site central nervous system relapse-refractory DLBCL responding to nivolumab and lenalidomide

    In Press, Corrected Proof, Available online 19 April 2019
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    Abstract

    Despite improvement in survival in diffuse large B-cell lymphoma (DLBCL) with the introduction of rituximab, central nervous system (CNS) relapse continues to represent a clinical challenge. In diffuse large B-cell lymphoma (DLBCL), the incidence of CNS relapse is only ∼5% in unselected cohorts. Immunotherapy is the treatment that either boosts the patient's own immune system or uses man-made versions of the normal parts of the immune system to kill lymphoma cells or slow their growth. We are presenting a thirty-eight year old man who, presented with neck nodes, axillary nodes, altered sensorium, abnormal body movements, unconsciousness, weight loss and, fever, with a past history of DLBCL in May 2008, treated with 6 cycles of CHOP and completed in November 2008. After 9 years in April 2018, the patient developed similar symptoms and treated with salvage chemotherapy with R-DHAP which was completed in September 2018. Post-treatment PET-CT showed partial metabolic response and we started external beam radiotherapy to initial bulky disease. After completion of radiotherapy, the patient was very reluctant for any type of therapy and went home. After one month he presented to us with persistent vomiting, abnormal body movements and, altered sensorium. On examination, his Glasgow Coma Scale (GCS) was E2V3M2 and he was admitted in Intensive Care Unit. The patient was managed with mannitol, dexamethasone, antiepileptics, antibiotics and other supportive care medicines. His brain magnetic resonance imaging (MRI) was showing multiple heterogeneously enhancing lesions with surrounding vasogenic oedema and his cerebrospinal fluid analysis was positive for malignant cells. He was managed with triple intrathecal chemotherapy with methotrexate 12 mg, Cytarabine 50 mg, and Hydrocortisone 50 mg along with other supportive care medicines, and after 4–5 days he regained consciousness and he was able to talk and understand verbal commands. In view of improvement in general condition and performance status, we started biweekly triple intra-thecal therapy, and Inj. Nivolumab 3 mg per kg q 2 weekly. From the second cycle, we started Lenalidomide 10 mg once a day for 21 days with 7 days gap along with 2 weekly nivolumab and biweekly triple IT chemotherapy. After one month his CSF analysis was negative for malignant cells. Now he is on regular treatment with weekly IT chemotherapy, 2 weekly nivolumab and 3 weeks on and one week off lenalidomide. After 2 months of treatment, his MRI Brain was showing. At the time of submission of this article, he has completed the fifth cycle of immunotherapy and two cycles of lenalidomide. He was able to manage his daily ADL and able to walk with a stick. The patient tolerated immunotherapy, triple IT therapy and lenalidomide very well without much intolerable side effects. Therefore, we concluded that nivolumab and lenalidomide was well tolerated and exhibited antitumor activity in extensively pretreated patients with relapsed or refractory sanctuary site CNS B- cell lymphomas. Additional studies of Nivolumab and lenalidomide in these diseases are ongoing.

  7. Human papillomavirus (HPV) vaccine and HPV-related head and neck cancer: What's next?

    In Press, Corrected Proof, Available online 5 April 2019
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Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Dental Sciences

Comparison of changes in retentive force and wear pattern of two stud attachments for implant overdentures: An in vitro study
Sajjy Upinder, Balvinder Singh Saluja, Gaurav Gupta, Bhupinder Kaur, Gurjot Singh

Indian Journal of Dental Sciences 2019 11(2):65-70

Context: Edentulous patients often complain about the instability of mandibular denture. To overcome that, implant-supported overdentures (IODs) have been applied as a good prosthetic option. Aims: The current study compared the changes in retentive force and patterns of surface wear of nylon rings of two stud attachments (ball and locator) upon cyclic loading. Subjects and Methods: Two implant analogs were fixed parallel to each other, 22 mm apart, in custom-made rectangular blocks for each attachment system. Ten nylon inserts of each attachment system were tested. Universal testing machine was used to measure the retentive force, and a low-value fatigue testing machine was used for cyclic loading of 2500 insertion–removal cycles. Surface changes of the components were evaluated by scanning electron microscope (SEM). Statistical Analysis Used: Paired Student's t-test was used to determine groups that were statistically significant. Results: The greatest retention loss rate, i.e., the difference between the initial retentive force and final retentive force was observed in the ball attachment (6.20 N) followed by locator attachment (3.70 N). The results were found to be statistically significant (d ≤ 0.001**). Upon SEM analysis, the nylon inserts of ball attachment revealed more surface wear compared to that of locator attachment. Conclusions: For greater retention and longer function, locator overdenture attachment should be preferred for implant overdentures over ball attachment.


To compare the efficacy of plasma glucose level, finger capillary blood, and gingival crevicular blood to measure blood glucose level in chronic periodontitis patients
Shireen Singh, Amit Bhardwaj, Priyanka Chopra, Sujata Masamatti

Indian Journal of Dental Sciences 2019 11(2):71-76

Background: A high number of patients with Periodontitis may have undiagnosed diabetes mellitus (DM). Diabetes is an associated risk factor for chronic periodontitis and has several other oral symptoms including dry mouth and oral infection. Expanding the role of the dentist may prove to be an efficient method of early detection and management of diabetes. Aim: The purpose of the present study was to evaluate whether blood oozing from gingival crevice during routine periodontal examinztion can be used for determining glucose levels. Materials and Methods: A total of 120 male/female patients with Chronic Periodontitis in the age group of 30 years and above were selected and divided into three groups i.e. Control Group (Plasma glucose level), Test Group 1 (Finger capillary blood) and Test Group 2 (Gingival crevicular blood). Blood glucose measurements were made using gingival crevicular blood and finger capillary blood using glucose self monitoring device (Accu-Chek Active) and at the same time venous blood was collected for measurement of serum (plasma) glucose. Data obtained were statistically analyzed using Paired t-test (p), and Pearson's correlation test (r). Results: The results revealed a strong correlation between (a) gingival crevicular blood and finger capillary blood (r = 0.999; P < 0.133); and also (b) between GCB and Plasma glucose level (r =0.984; P < 0.230). Conclusion: The data from this study has shown that gingival crevicular blood collected during diagnostic periodontal examination can be an excellent source of blood for glucometric analysis. GCB can be used as a marker for blood glucose estimation using glucometer. The technique described is safe, easy to perform and helps to increase the frequency of diabetes screening in dental office. 


Evaluation of awareness toward various treatment modalities for replacement of teeth in local population of Sundar Nagar, District Mandi, Himachal Pradesh: A survey report
Amit Kumar, Rajeev Gupta, Archana Nagpal, Rupandeep Kaur Samra, Jasjit Kaur, Alisha Babbar

Indian Journal of Dental Sciences 2019 11(2):77-82

Background: The purpose of the study was to collect information from local population of Sundar Nagar, District Mandi, Himachal Pradesh, to assess their attitude toward replacement of teeth. Materials and Methods: An analytical, cross-sectional, epidemiological survey was conducted on 522 individuals randomly selected from a local population of Sundar Nagar, to determine attitude toward various treatment modalities for the replacement of teeth. A self-designed closed-ended questionnaire was prepared to assess the attitude of the patient, and collected data were analyzed statistically using the Chi-square test at the significance level of P < 0.05. Results: Around 87% of patients showed positive attitude for the replacement of missing teeth. Almost 78.2% of patients liked to replace missing teeth even although it is an expensive treatment. Around 47.1% of patients believed that they socialized less with a removable prosthesis because of poor stability and retention. Eighty-eight percent of patients of 40–59 years showed a positive attitude toward fixed prosthesis as compared to older age, who preferred removable prosthesis due to lack of interest in esthetics and low perceived need of prosthesis. Forty-seven percent of patients showed a positive attitude toward acceptance of implant. Conclusion: It is essential to evaluate attitude toward treatment as treatment expectations may influence treatment planning and perceived value by the patient and its outcome. 


Clinical and radiographic evaluation of autogenous dentin graft and demineralized freeze-dried bone allograft with chorion membrane in the treatment of Grade II and III furcation defects-: A randomized controlled trial
Guntakala Vikram Reddy, Atchuta Abhinav, Suryakanth Malgikar, Ch Bhagyashree, P Raja Babu, G Jagadish Reddy, S Vidya Sagar

Indian Journal of Dental Sciences 2019 11(2):83-89

Background: Periodontal Regeneration of any tissue type is a complex biological process in itself, requiring a triad of cells, locally acting growth factors, systemic hormones, and the extracellular matrix components in which these interact. Aims: The aim of this study was to compare the effectiveness of autogenous dentin graft (ADG) and demineralized freeze-dried bone allograft (DFDBA) with chorion membrane in the treatment of Grade II and III Furcation defects in patients with moderate-to-severe chronic periodontitis. Subjects and Methods: A total of 20 Grade II and III furcation defects in patients with moderate-to-severe chronic periodontitis were randomly assigned to either Group I (ADG + chorion membrane) or Group II (DFDBA + chorion membrane) and evaluated clinically for Gingival Index (GI), probing pocket depth (PPD), clinical attachment level (CAL), vertical bone depth (VBD), and horizontal bone depth (HBD) and radiographically for furcation bony defect (FBD). Results: Intragroup comparisons of clinical parameters GI, PPD, and CAL have shown a statistically significant reduction at the end of 3 months and 6 months, but intergroup comparison was not statistically significant. At the end of 6 months, there was a significant reduction in VBD in Group I (2.65 ± 0.71 mm) compared with Group II (4.00 ± 1.26 mm) and HBD (1.84 ± 0.59 mm) compared with Group II (3.95 ± 1.74 mm), respectively. At the end of 3 months and 6 months, FBD depth was significantly reduced in Group I (1.21 ± 1.10 and 0.43 ± 0.22 mm2, respectively) compared with the Group II (3.04 ± 2.45 and 2.68 ± 2.50 mm2, respectively). Conclusions: The results of the present study indicate that the use of ADG and chorion membrane improved all the clinical parameters. Individuals treated with ADG and chorion membrane showed significant reduction for VBD, HBD, and FBD in the treatment of Grade II and III furcation defects than in the individuals treated with DFDBA and chorion membrane. 


Information content of youtube videos on orthognathic surgery – Helpful?
Jasmine Grewal, Gayathri Marria, Saurabh Goel

Indian Journal of Dental Sciences 2019 11(2):90-94

Aim: The aim of this study is to investigate the accuracy of the information provided by YouTube videos regarding orthognathic surgery. Methods and Materials: YouTube was searched for four keywords such as orthognathic surgery, orthodontic surgery, jaw surgery, and jaw corrective surgery. While the videos having English language, primary content related to orthognathic surgery, and acceptable audio-visual quality were included in the study, the videos with non-English language, lacking audio or visuals, satirical videos, drama-based videos, and news stories were excluded for the study. YouTube advanced search option “sort by view count” was used. Videos were sorted into top 50 for each search term and overall into top 55 from the four searches. Video assessment was done based on the number of views, likes, dislikes, source, and primary intention. Every video was classified as “excellent,” “moderate,” or “poor” according to information content it provided. A predetermined list of orthognathic surgery-related information domains was also evaluated. Statistical Analysis Used: STATA version 8.2 was used. Results: The top 55 videos had a combined total of 7,663,296 views. Videos predominantly involved patients describing their personal experience (34.54%) and majority were positively biased (85.45%). While only 27.27% of videos were classified as having excellent general information, 61.81% of videos had moderate information and 10.90% videos provided poor information content. Conclusions: Information available on YouTube is of moderate quality, and patients should consult dentists regarding questions related to orthognathic surgery. 


Evaluation of knowledge and awareness among dental students and private dental practitioners about the emerging trend of travel medicine in and around Kanpur City
Kriti Garg, Rohan Sachdev, Devina Pradhan, Garima Singh

Indian Journal of Dental Sciences 2019 11(2):95-98

Context: For the evaluation of knowledge among dental students and practitioners. Aims: Travelers play a significant role in the spread of infections across various international borders, through their travel patterns. The aim of this study was to evaluate the knowledge and awareness among dental students and dental practitioners regarding the emerging trend of travel medicine in and around Kanpur city. Settings and Design: A descriptive, cross-sectional questionnaire study was performed. Subjects and Methods: The present study was performed at a private dental college in Kanpur from June to July 2018. A total of 450 dental students and dental practitioners of both genders were included in the study. Statistical Analysis Used: The collected data were analyzed by using appropriate statistical software. Results: A total of 190 males and 260 female respondents participated in the study, out of which 130 participants were married and 320 were single. Seventy respondents were aware of the concept of travel vaccines, whereas 30 respondents could give correct definition of travel medicine. Knowledge regarding travel medicine was found to be very poor, 310 of the total respondents were unaware of the uptake of travel vaccine. Conclusions: The present study suggests that, by increasing the knowledge regarding travel medicine uptake through various educational programs not only among dental students and dental practitioners but also among their families, the more uptake of travel medicine will be helpful in preventing various disease spread as these dental professionals may be helpful to educate their patients regarding vaccination during traveling. 


Comparison of various sealers on postoperative pain in single-visit endodontics: A randomized clinical study
Shahnaz Nabi, Riyaz Farooq, Aamir Purra, Fayaz Ahmed

Indian Journal of Dental Sciences 2019 11(2):99-102

Aim: The aim of this study is to evaluate the effect of bioceramic-based sealers on postendodontic pain following single-visit endodontics. Materials and Methods: Ninety patients requiring primary endodontic treatment were selected for the study. Patients were treated in single visit endodontically using three different bioceramic-based sealers: Group 1: obturation done using mineral trioxide aggregate plus sealer, Group 2: obturation done using EndoSequence BC sealer, and Group 3: iRoot SP sealer. Postendodontic pain was measured for 48 h postoperatively. Results: No significant difference was found in postendodontic pain scores between the sealers groups. Conclusion: Postendodontic pain was reduced in all treatment groups. Any of the three bioceramic sealers can be used for single-visit endodontics without fear of postoperative pain. 


A phase contrast cytomorphometric study of oral exfoliated cells in diabetes mellitus patients - An original study
RG Mridula, S Akhil, RB Vinod Kumar, Jubin Thomas, Ajish M Saji, Amal K Iype

Indian Journal of Dental Sciences 2019 11(2):103-107

Background of Study: Diabetes is the most common endocrine-metabolic disease affecting worldwide. Diagnosis of type 2 diabetes with the help of oral exfoliative cytology is a simple, noninvasive technique. Evaluation of cytomorphometric changes in exfoliated buccal cells in diabetes can help in the early detection and examination of diabetes. Aim: The aim is to study and compare the cytomorphometric features of buccal mucosal cells of normal individuals and type 2 diabetes patients and to evaluate the role of phase-contrast microscopy for visualizing cytomorphological changes in unstained smears. Materials and Methods: Fifty known type 2 diabetic patients and fifty healthy individuals were taken as study group and control group, respectively. Smears were prepared from the buccal mucosa of both study and control groups. Fixed, unstained smears were viewed under phase-contrast microscope, and cytomorphometric analysis was done using image analysis software for evaluating nuclear area (NA), cytoplasmic area (CyA), and nuclear/cytoplasmic ratio. Results: A statistically significant increase in NA(P = 0.000), CyA (P = 0.000), and N/Cy ratio (P = 0.000) was obtained from the smears of the study group when compared with the control group. Conclusions: Cytomorphometric analysis of exfoliated cells can aid in predicting systemic disease such as type 2 diabetes. With the use of phase-contrast microscope, the cellular details can be easily and quickly evaluated and it is a cost-effective method in cytomorphometric studies. 


Simple technique to fabricate a crown for abutment of an existing cast partial removable denture
Shefali Singla, Amarpreet Kaur, Manu Rathee

Indian Journal of Dental Sciences 2019 11(2):108-111

The requirement of full crown restoration for abutments of existing Cast partial removable denture is common. Retrofitting a crown to existing cast partial denture (CPD) clasps and guiding planes is a challenging task. Literature describes various direct, indirect, and direct-indirect techniques to overcome this dilemma. All these involve elaborate steps, necessitating refabrication of CPD or extended clinical adjustment time for ensuring a proper fit that is elusive in most cases and also patient has to do without CPD during laboratory procedure. The recent use of computer-aided design-computer-aided manufacture technology for this purpose is proving to be a promising but expensive option. A simple technique is presented here to generate a blueprint of required final contours to facilitate a fully contoured metal crown to fit under an existing CPD. 


Frenectomy with laterally displaced flap: A case series
S Janarthanan, RT Arun, S Srinivasan, S Senthil Kumar

Indian Journal of Dental Sciences 2019 11(2):112-115

The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. The frena may jeopardize the gingival health when they are attached too closely to the gingival margin, either due to an interference in the plaque control or due to a muscle pull. In addition to this, the maxillary frenum may present esthetic problems or compromise the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. Archer's “classical frenectomy” is an extensive procedure including the excision of fibers, interdental papilla, and exposure of the alveolar bone up to the palatine papilla. The resultant delayed healing, loss of the interdental papilla, and abnormal scar led toward the conservative approaches such as Edward's frenectomy, frenum relocation by Z-plasty, and free gingival graft, with their technical and esthetic limitations. A better approach in frenectomy to make a primary closure in the midline and to avoid an unesthetic scar by creating a zone of the attached gingiva is assisted with a lateral pedicle graft. A case series of this technique with its distinct advantages is presented. 


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Pulmonology

How to optimize aerosol drug delivery during noninvasive ventilation: What to use, how to use it, and why?
Arzu Ari

Eurasian Journal of Pulmonology 2019 21(1):1-8

Much evidence supports the use of non-invasive ventilation (NIV) in patients who have acute and chronic respiratory failure and aerosolized medications are increasingly used in this patient population. Successful application of aerosol therapy during NIV depends on the effectiveness of the drug deposition in the lungs. Previous evidence showed that many factors impact aerosol delivery to patients receiving NIV. Those factors include mode of ventilation, ventilator parameters, type of ventilator circuit, the position of the aerosol device, the location of leak port, type of exhalation valve, humidity, enhanced condensational growth, type of aerosol device, and interface as well as delivery technique. The purpose of this paper is to review the available evidence related to aerosol therapy during NIV and provide recommendations to optimize aerosol drug delivery to patients receiving NIV. 


Silent enemy: Environmental tobacco smoke
Evrim Eylem Akpinar

Eurasian Journal of Pulmonology 2019 21(1):9-13

Second-hand smoke, also known as environmental tobacco smoke (ETS), is one of the most harmful indoor pollutants. Exposure to ETS is a worldwide silent cause of mortality and morbidity. Although ETS had been decreased for 20 years, a lot of people who do not smoke still exposed to ETS at home, work, public places, and in vehicles. ETS is a risk factor for many important diseases such as lung cancer, chronic obstructive lung disease, asthma, cardiovascular diseases, upper and lower respiratory tract infections, and sudden infant death. In this article, the harmful effects of ETS and the effects of smoke-free environment regulation on ETS exposure were reviewed. 


Effect of low-intensity pulmonary rehabilitation program on quality of life and pulmonary functions in patients with stable chronic obstructive pulmonary disease
Sule Cilekar, Baykal Tülek, Fikret Kanat, Mecit Süerdem, Funda Levendoglu, Ibrahim Tugrul Taşpınar

Eurasian Journal of Pulmonology 2019 21(1):14-20

OBJECTİVES: The effectiveness of low-intensity pulmonary rehabilitation program applied patients with chronic obstructive pulmonary disease (COPD) in terms of exercise capacity, dyspnea scale, life quality and respiratory muscle strength. METHODS: The study included 30 patients with COPD. The program was 3 days in a week, for a 6 weeks period between December 1st 2012 and August 31st 2013. Arterial blood gas (ABG), 6 minute walking test (SMWT), respiratory function tests and respiratory muscle strength were evaluated before and after treatment. St George's breathing questionnaire (SGRQ) was used to assess quality of life. The dyspnea scores were assessed by the Modified Medical Research Council (mMRC) and the COPD Assessment Test (CAT). Patient approvals were obtained for the study. For analysis of results kolmogorov smirnov test, shapiro – wilk test, wilcoxon test and sample ttest were used. RESULTS: Of 30 patients participated in our study, 26 completed the treatment program. There were increases in SMWT distance (P = 0.049), forced expiratory volume in one second, and forced expiratory flow (FEF 25-75) value (P < 0.05); and decreases in mMRC dyspnea scale score (P = 0.001), CAT score (p=0.003) and SGRQ score (P <= 0.001). Maximum inspiratory pressure and maximum expiratory pressure values and ABG parameters did not show significant change. CONCLUSION: Low intensity pulmonary rehabilitation therapy has positive effects on exercise capacity, dyspnea scale, walking distance, and quality of life. Patient compliance was high in this treatment modality so according to our study results, low intensity pulmonary rehabilitation treatment can be prefer to high intensity pulmonary rehabilitation treatment in COPD. 


The relationship of bronchiectasis to airway obstruction and inflammation in patients with chronic obstructive pulmonary disease
Baris Seker, Burcu Arpinar Yigitbas, Celal Satici, Sibel Yurt, A Filiz Kosar

Eurasian Journal of Pulmonology 2019 21(1):21-28

Background: Chronic obstructive pulmonary disease (COPD) and bronchiectasis are diseases of respiratory tract with significant mortality and morbidity. These two diseases can be seen together occasionally and are thought to change each other's course by adversely affecting the prognosis. The aim of our study was to identify the signs of bronchiectasis in COPD patients, to investigate its possible effects on disease prognosis, and to evaluate these signs for diagnostic convenience. Materials and Methods: This prospective study included a total of s[table 60] moderate/severe COPD patients who were admitted to Yedikule Chest Diseases and Chest Surgery Training and Research Hospital between January 2015 and February 2016. The patients were divided into two groups according to the presence of bronchiectasis as confirmed radiologically: 35 patients in the bronchiectasis group and 25 patients in the control group. Demographic data of the patients were questioned and systemic inflammation parameters, spirometric measurements, blood gas analysis, and clinical evaluation findings were recorded. Results: Bronchiectasis was detected in 58.3% of COPD patients. Patients in two groups are similar in sociodemographical, spirometrical and clinical parameters (P > 0.05). Laboratory tests showed similar result in between two groups but carbon dioxide(CO2) values in the blood gas analysis were found to be higher in the bronchiectasis group (P < 0.05). The increase in the number of bronchiectasis segments was shown to reduce the FEV1/FVC (P < 0.05). In the overall evaluation, FEV1%, mMRC, FVC% and CRP levels were found to be associated with exacerbations in COPD (P < 0.05). The use of antibiotics increased as FEV1% and FEV1/FVC levels of patients decreased (P < 0.05). In addition, sputum polymorphonuclear leukocyte (PMNL) values were correlated with spirometric values and as sputum PMNL values increased, spirometric values were found to decrease (P < 0.05 for FEV1% and FVC%). Conclusion: Bronchiectasis is common in COPD patients. In two divided groups, blood gas carbon dioxide values, which affect mortality, were shown to be higher in the bronchiectasis group. This is a new addition to literature that bronchiectatic COPD patients are experiencing different respiratory failure patterns affecting mortality. Diffuse type bronchiectasis has more effect in spirometric results of COPD patients. Also, airway obstruction in COPD is well correlated with elevated sputum PMNL values which represent airway inflammation and if this is combined with high clinical suspicion it guides to a cost effective way for guiding radiological investigations for bronchiectasis. 


The value of preoperative pulmonary assessment in predicting postoperative pulmonary complications
Ozlem Ercen Diken, Nevin Fazlıoǧlu, Nurhan Sarıoǧlu, Nalan Ogan, Nafiye Yılmaz, Hakan Tanrıverdi, Aysun Şengül, Emre Demir, Akif Turna, Arzu Mirici

Eurasian Journal of Pulmonology 2019 21(1):29-37

OBJECTIVE: We aimed to determine the preoperative parameters that may predict postoperative pulmonary complications (POPCs) and the value of some current practical indexes in predicting POPCs. MATERIALS and METHODS: Our study is a retrospective cohort study carried out in 9 different centers. Patients admitted to the chest diseases outpatient clinic for preoperative evaluation were followed up during the 6-month study period. Patients with or without postoperative complications were evaluated retrospectively, and the effect of some parameters and indexes recorded during the preoperative evaluation of chest diseases on POPC development was investigated statistically. RESULTS: A total of 307 patients were included in the study. POPCs were observed in 100 patients (32.6%). About 13% of these complications were respiratory tract infections, 59% were respiratory failure, 45% were pleural effusion, and 42% were atelectasis, which were the most common pulmonary complications. The probability of experiencing POPCs by patients with chronic obstructive pulmonary disease (COPD) is 2.5 (1.18–5.67) times more than those without COPD. We determined that patients with the history of upper respiratory tract infection during the preoperative period are 5.3 times more likely to have POPCs; similarly, the number was 4.7 for patients undergoing cardiac operation and 3.3 for patients with interstitial infiltration. CONCLUSION: The risk of pulmonary complications was higher for those with the history of upper respiratory tract infection during the preoperative period, those undergoing cardiac surgery, those with the shortness of breath, those with the history of COPD, and those with the reticular/interstitial infiltrations in the chest X-ray. These parameters should be examined carefully in the preoperative period and should be careful in terms of pulmonary complications that may develop during the postoperative period. 


Tuberculin skin test evaluation in healthcare workers and distribution by occupation
Sami Deniz, Jülide Çeldir Emre

Eurasian Journal of Pulmonology 2019 21(1):38-43

OBJECTIVE: Tuberculosis (TB) is a potential occupational threat for healthcare workers (HCWs) worldwide. We aimed to evaluate the tuberculin skin test (TST) and investigated if there was any difference between occupations. METHODS: This was designed as a prospective study. The analysis was performed on 331 participants. Purified protein derivative was administered to all cases. In addition, cases' age, gender, and smoking status were questioned and their comorbidities were recorded. Both shoulder areas were checked, and the Bacille Calmette-Guérin (BCG) scar counts were recorded. RESULTS: Out of a total of 331 participants, 207 were female and 124 were male; mean age was 39 ± 8 (min; 18, max; 61) and TST was 12 ± 6 mm. The cases were categorized by considering participants' exposure to TB (Group-1 - Doctor; Group-2 - Midwife-Nurse-Health Technician-Laboratorian; Group-3 - Technician-Administrative Staff; Group-4 - Secretary-Auxilliary Staff; and Group-5 - Security, Cleaning, Cafeteria Staff). When compared in terms of TST, there was a statistically significant difference (P < 0.001). The cases had at least 1 and maximum 3 BCG scars. Based on this, three groups were formed. Two hundred and twenty-three cases had 2 scars, 58 had 1, and 41 had 3. Significant difference was found among three groups, and similarly, there was a statistically significant difference in paired comparisons (P < 0.001; for all comparisons). While the difference was detected in the group with two BCG scars, there was no difference in other groups (P = 0.7, 0.001, and 0.5, respectively). There was a significant difference in terms of TST between genders (P < 0.001). CONCLUSION: Exposure to TB may vary according to professions, but the socioeconomic situation cannot be determined by professions. 


The evaluation of psychological status in newly diagnosed chronic obstructive pulmonary disease patients
Onur Turan, Pakize Ayse Turan, Arzu Mirici

Eurasian Journal of Pulmonology 2019 21(1):44-49

BACKGROUND: As chronic obstructive pulmonary disease (COPD) and its symptoms may change psychological attributes, psychiatric disorders may be seen in COPD. AIMS: We aimed to assess the effect of taking diagnosis of COPD and using bronchodilator therapy on the psychological status of COPD patients. MATERIALS AND METHODS: It is a cross-sectional study including newly diagnosed COPD outpatients. Spirometry, Hospital Anxiety and Depression Scale (HADS), Beck Depression Inventory (BDI), and St. George's Respiratory Questionnaire (SGRQ) were performed at the first visit (date of new diagnosis) and 6 months later as the second visit. RESULTS: Ninety new diagnosed COPD patients (71 men and 19 women) with a mean age of 61.7 ± 9.8 were included. There were high scores of anxiety in 23.5% and depression in 38.2% (HADS)–52.9% (BDI) patients at the first visit. The symptoms about anxiety reduced to 19%, depression to 33.3% (HADS)/47.6% (BDI) six months later. All the participants who were active smokers had lower spirometric levels (42.9%) at the second visit compared with the first visit levels. There was an improvement in psychological status and quality of life (QOL) (P < 0.001). There was a negative correlation between SGRQ score and forced expiratory volume in 1 s levels (P = 0.045) and positive correlation of SGRQ score with HAD and BDI scores (P = 0.041 and 0.011). Participants who quitted smoking in 6-month period had statistically lower anxiety and depression scores (P = 0.003 and 0.026). CONCLUSION: Depression and anxiety states are frequent among COPD patients. Pulmonary symptoms may regress with the bronchodilator therapy at newly diagnosed COPD patients, which can cause an improvement in pulmonary functions, psychological status, and QOL. Psychological aspects need to be carefully assessed in patients with new diagnosis of COPD. 


The relationship between treatment cost and prognosis of malignant pleural mesothelioma in Turkey
AK Guntulu, Selma Metintas, Tunc Kose, Filiz Bogar, Nuray Girginer, Hasan Fevzi Batırel, Nurullah Uckun, Muzaffer Metintas

Eurasian Journal of Pulmonology 2019 21(1):50-56

BACKGROUND: Malignant pleural mesothelioma (MPM) is endemic in the population exposed to asbestos and has high health-care cost with a limited life expectancy. The aim of this study is to evaluate the relationship between cost according to treatment type and prognosis in MPM. MATERIALS AND METHODS: A total of 309 patients with MPM were evaluated. Direct medical costs were estimated as the sum of hospital bills attributed to MPM for all patients followed up from hospital application to death. Three treatment strategies were compared to each other in terms of survival and median incremental costs per month gained cost. RESULTS: The mean age of the patients was 63.2 ± 11.2 years. The total median costs per patient and median survivals were $1838 and 5 months, $10,540 and 11 months, and $17,022 and 22 months for the best supportive care, the chemotherapy, and the multimodality groups, respectively. Factors affecting the cost of MPM were histology, treatment type, received second- and third-line chemotherapy, and number of hospitalization. CONCLUSION: MPM has a limited survival time despite treatment, and treatment cost is relatively high by prolongation of lifetime. Chemotherapy and multimodality approaches seem to be cost-effective until to be find more effective targeted therapies. 


Correlation between the probability of malignancy and maximum standard uptake values of mediastinal lymph nodes on 18F-FDG positron emission tomography scan sampled by endobronchial ultrasound-guided-transbronchial needle aspiration:A retrospective analysis
Ali Kadri Cirak, Sami Deniz, Yelda Varol, Görkem Vayisoglu, Serpil Tekgül, Dursun Alizoroglu, Enver Yalniz

Eurasian Journal of Pulmonology 2019 21(1):57-62

INTRODUCTION: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is frequently used as an important initial investigation for diagnosing and staging for both suspected malignant and benign mediastinal lesions for the last 10 years. AIM: We aimed to analyze the correlation between probability of malignity by EBUS-TBNA and maximum standard uptake value (SUVmax) obtained by 18F-labeled fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET CT). METHODS: This is a retrospective study using hospitals' database records. Demographic features of the patients, characteristics of the biopsied lymph nodes (LNs), PET-CT results, and SUVmax are obtained from hospital database system. RESULTS: A total of 322 patients underwent EBUS-TBNA for a final diagnosis. The mean age was 59.4 years. The most common final diagnosis was nonsmall cell lung cancer. When we compared the average SUVmax, as the SUVmax increased, the probability of malignity increased significantly (P < 0.001). We studied a Youden index for SUVmax and the cutoff point for SUVmax was 9 for 54.39% sensitivity and 79.1% specificity. CONCLUSION: Our study in a real-life setting showed that EBUS-TBNA is effective in diagnosing patients who had mediastinal LNs suspected of malignancy. We also showed that as the SUVmax increased, the probability of malignancy increased. We believe that more data are needed from a larger number of patients from different centers. 


The Course of Renal Functions in COPD. Two Statition: Exacerbation and Stable Period
Ayse Baha, Nalan Ogan, Evrim Eylem Akpinar, Can Ateş, Meral Gülhan

Eurasian Journal of Pulmonology 2019 21(1):63-68

OBJECTIVE: Comorbidities in chronic obstructive pulmonary disease (COPD) are important factors that determine the prognosis of the disease. However, there are few studies about renal dysfunction. We aimed to compare the renal functions in COPD patients with stable and exacerbation periods and to determine the frequency of acute renal failure (ARF) during exacerbation. MATERIALS AND METHODS: The files of 320 patients with COPD (forced expiratory volume in 1 s/forced vital capacity <70% in pulmonary function test) who were admitted to our hospital between 2015 and 2016 were evaluated retrospectively. After exclusion criteria, 113 patients were included in the study. Data were analyzed by appropriate statistical method. RESULTS: Ninety (80.4%) of the patients were male and 23 (19.6%) were female. In the exacerbation period, blood urea nitrogen (P < 0.001), creatinine (P < 0.001), white blood cell (P < 0.001), C-reactive protein (P < 0.001), and sedimentation (P < 0.001) were higher than that in the stable period. Furthermore, hemoglobin (P = 0.021) and estimated glomerular filtration rate (eGFR) (P < 0.001) were significantly lower. The number of emergency department admission in patients with eGFR <60 ml/min during the exacerbation more than the patients with eGFR ≥60 ml/min. Twenty (17.7%) patients have developed ARF during exacerbation (eGFR <60 ml/min). CONCLUSION: In COPD exacerbation period, kidney function is affected negatively in most patients (even if it does not reach the ABY border) and tends to improve in the stable period. In patients with COPD, it is thought that the causes of respiratory failure negatively affect renal function. 


Alexandros Sfakianakis
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