Black and White Patients with Staphylococcus aureus Bacteremia have Similar Outcomes but Different Risk Factors

alexandrossfakianakis shared this article with you from Inoreader Black and White Patients with Staphylococcus aureus Bacteremia have Similar Outcomes but Different Risk Factors via Clinical Infectious Diseases Advance Access Abstract BACKGROUND Staphylococcus aureus bacteremia (SAB) disproportionately affects Black patients. The reasons for this disparity are unclear. METHODS We evaluated a prospectively ascertained cohort of patients with SAB from 1995 to 2020. Clinical characteristics, bacterial genotypes, and outcome were compared among Black and White patients with SAB. Multivariable logistic regression models were used to determine factor s independently associated with the outcomes. RESULTS Among 3068 patients with SAB, 1107 (36%) were Black. Black patients were younger (Median: 56 years vs. 63 years; p < 0.001), had higher rates of diabetes (47.5% vs. 34.5%; p < 0.001), hemodialysis dependence (40.0% vs. 7.3%; p < 0.001), and HIV (6.4% vs. 0.6%; p < 0.001). Black patients had higher rates of methicillin-resistant S. aureus (49.3% vs 44.9%; p = 0.020), including the USA300 hypervirulent clone (11.5% vs. 8.4%; p = 0.007). White patients had higher rates of corticosteroid use (22.4% vs. 15.8%; p < 0.0001), and surgery in the preceding 30 days (28.1% vs. 18.7%; p < 0.001). Although median Acute Physiology Score (APS) at the time of initial SAB diagnosis was significantly higher in Black patients (Median APS 9, Interquartile Range [IQR] 5-14; vs. Median APS 7, IQR: 4-12; p < 0.001), race was not associated with 90-d ay mortality (risk ratio (RR): 1.02; 95% CI: 0.93–1.12, and rates of metastatic infection were lower among Black patients (37.2% vs. 41.3% White; p = 0.029). CONCLUSIONS Despite differences in Black patients' higher APS on presentation and more risk factors, including a 5 times higher risk of hemodialysis dependence, 90-day mortality among Black and White patients with SAB was similar. View on Web

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Diagnostic Criteria for Temporomandibular Disorders − INfORM recommendations: Comprehensive and short‐form adaptations for children

alexandrossfakianakis shared this article with you from Inoreader Diagnostic Criteria for Temporomandibular Disorders − INfORM recommendations: Comprehensive and short‐form adaptations for children via Journal of Oral Rehabilitation Abstract Background The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. Objective To present comprehensive and short-form adaptations of Axis I and II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings. Methods Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children. Results The proposed adaptation is suitable for children aged 6−9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire, and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, and (ii) adding anxiety and depression assessments that have been validated in children, and (iii) adding three constructs (stress, catastrophizing, and sleep disorders) to assess psychosocial functioning in children. Conclusion The recommended DC/TMD, including Axis I and Axis II, for children aged 6−9 years, is appropriate for use in clinical and research settings. This adapted first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation. View on Web

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Full arch immediate occlusal loading using site specific implants: a clinical series of 10 patients (13 arches)

alexandrossfakianakis shared this article with you from Inoreader Full arch immediate occlusal loading using site specific implants: a clinical series of 10 patients (13 arches) via Journal of Prosthodontics Abstract Purpose Osseointegration of dental endosseous implants has proven to be effective, predictable, and clinically successful. Unloaded healing protocols were originally used in treating edentulous patients. Full arch immediate occlusal loading protocols have been shown to be as effective as unloaded healing protocols. This paper reports on the results, benefits, and limitations of one specific immediate loading protocol using site specific implants for fresh extraction and healed extraction sites. Materials and Methods Ten consecutive patients [{13 arches} (age range: 64–81 years; average: 70.1) (4 males/6 females) were treated by the first 2 authors in private practice settings. Hopeless teeth were scheduled for extraction with immediate implant placement and immediate loading with insertion of full arch, screw-retained, acrylic resin interim prostheses within 24 hours. Implants were also placed into healed edentulous ridges. Insertion torque values for each implant were recorded. Interim prostheses were removed after at least 3 months of healing. Implants were reverse torque tested (35Ncm) and evaluated for macroscopic mobility. Definitive full arch prostheses were made. Patients were followed for 21- 48 months post implant surgery. Panoramic radiographs were taken immediately post implant placement and one year post operative. Results Thirteen arches were treated; 11 ultrawide diameter implants were placed into molar sockets, 26 inverted body-shift implants were placed into anterior sockets; 25 standard diameter, tapered implants were placed into edentulous sites; 2 zygomatic implants were placed in one patient. The total number of implants placed was 64 (4 pre-existing implants were also used and not included in this study). The minimum implant insertion torque value was 20Ncm. After 12–18 months of function (average 14 months), the implant and prosthetic survival rates were 100%. Eight patients were restored with definitive zirconia or acrylic resin hybrid fixed prostheses. Two patients were restored with bar titanium frameworks and removable overdenture prostheses. No prosthetic complications were reported for the definitive prostheses. Conclusions The results of this clinical series with site specific implants and immediate full arch occlusal loading in treating edentulous patients resulted in 100% clinical implant and prosthetic survival rates. According to this study, this protocol can be used with high levels of anticipated success. This article is protected by copyright. All rights reserved View on Web

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Gastrectomy Versus Esophagectomy for Gastroesophageal Junction Tumors: Short- and Long-Term Outcomes From the Dutch Upper Gastrointestinal Cancer Audit

alexandrossfakianakis shared this article with you from Inoreader Gastrectomy Versus Esophagectomy for Gastroesophageal Junction Tumors: Short- and Long-Term Outcomes From the Dutch Upper Gastrointestinal Cancer Audit via Annals of Surgery - Most Popular Articles Objective: Investigate long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for gastroesophageal junction (GEJ) cancer. Background: Both a total gastrectomy and an esophagectomy may be valid treatment options in patients with GEJ cancer. Which procedure results in the most optimal patient outcome is not well studied. The aim of this study was to investigate the long-term survival, morbidity, mortality, and pathology results in patients following esophagectomy or total gastrectomy for GEJ cancer. Methods: A retrospective comparative cohort study of prospectively collected data from the Dutch Upper GI Cancer Audit combined with survival data of the Dutch medical insurance database was performed. Patients with GEJ cancer in whom a total gastrectomy or an esophagectomy was performed between 2011 and 2016 were compared. The primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, radicality of resection, and lymph node yield were secondary endpoints. Results: A total of 871 patients were included: 790 following esophagectomy and 81 following gastrectomy. The 3-year overall survival was 35.8% after esophagectomy and 28.4% after gastrectomy (hazard ratio 1.2, 95% confidence interval 0.721–1.836, P = 0.557). Postoperative morbidity, mortality, radicality of resection, lymph node yield, and 3-year conditional survival did not differ significantly between groups. Conclusion: A total gastrectomy and an esophagectomy for GEJ cancer show largely comparable results with regard to long-term survival, postoperative morbidity, mortality, and pathology results. If both procedures are feasible, other parameters such as surgeon's experience and quality of life should be considered when planning for surgery. View on Web

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