Obstructive sleep apnea is a sleep disorder of airflow at the nose and mouth during sleep. Patients with undiagnosed
sleep apnea represent a major public health problem. Dental professionals have a unique doctor patient relationship
that can help them in recognizing the sleep disorder and co-managing the patients along with a physician or a sleep
specialist. Oral appliance therapy is an important treatment modality for sleep apnea patients. This article discusses
the etiology, clinical features, diagnosis and various treatment options with special reference to oral appliances used for obstructive sleep apnea.
The document discusses various jobs in the medical field organized into four levels: professional, technical, administrative, and clerical/manual. Professional roles include doctors, dentists, pharmacists, podiatrists, veterinarians, optometrists, and radiologists. Technical roles include nurses, medical lab technicians, and x-ray technicians. Administrative roles include hospital administrators and medical records managers. Clerical and manual roles include customer service representatives, orderlies, and medical assistants. The document then provides brief descriptions of some of these roles.
There are many different types of doctors that specialize in various areas of the body and health. The document outlines over 30 different types of doctors including cardiologists, dermatologists, neurologists, psychiatrists, surgeons, and more. Each doctor specializes in a specific area of the body or medical condition. Knowing the different types of doctors and their specializations can help choose the right doctor when needing medical care for a particular illness or condition.
The document summarizes the history and development of sleep medicine in Malaysia. It discusses the founding of the Sleep Disorders Society of Malaysia in 2001 with its objectives to foster research collaboration and education. It outlines the challenges in training technicians and doctors in sleep medicine. It also discusses future directions such as establishing clear policies, multi-disciplinary clinics, and large epidemiological studies to better understand sleep disorders in Malaysia.
This document outlines objectives and content for a chapter on airway management, ventilation, and oxygenation. It includes reviews of respiratory system anatomy and physiology, pathophysiology of respiratory issues, assessment of airway and breathing, and management of unresponsive patients. The objectives cover topics like airway anatomy, abnormal breath sounds, oxygen administration, and ventilation techniques.
This document discusses evidence for preventing ventilator-associated pneumonia (VAP) through appropriate oral care for mechanically ventilated patients in intensive care units. It reviews literature showing that VAP increases mortality and hospital stay. Chlorhexidine oral care is shown to be more effective at preventing VAP than tooth brushing alone, as it has bactericidal properties, while brushing only reduces bacteria. Studies also find developing VAP is associated with changes in oral health for intubated neuroscience ICU patients. The best practice for VAP prevention is a combined approach including chlorhexidine oral care along with other measures like head elevation and limiting hospital stay.
To hop 3 thao duoc co tac dung tuong tu corticoidNgoc Dang
This study compared the efficacy and safety of an antiasthma herbal medicine intervention (ASHMI) to prednisone for treating moderate-severe allergic asthma. In a double-blind randomized controlled trial, 91 adult asthma patients received either ASHMI capsules with prednisone placebo or prednisone tablets with ASHMI placebo for 4 weeks. Both treatments significantly improved lung function and reduced symptoms and IgE levels. However, prednisone further reduced TH2 cytokines and cortisol levels while ASHMI increased TH1 cytokines and cortisol levels. No severe side effects occurred with either treatment. The study suggests ASHMI is a safe and effective alternative asthma treatment to prednisone without adverse effects on adrenal
The document discusses various jobs in the medical field organized into four levels: professional, technical, administrative, and clerical/manual. Professional roles include doctors, dentists, pharmacists, podiatrists, veterinarians, optometrists, and radiologists. Technical roles include nurses, medical lab technicians, and x-ray technicians. Administrative roles include hospital administrators and medical records managers. Clerical and manual roles include customer service representatives, orderlies, and medical assistants. The document then provides brief descriptions of some of these roles.
There are many different types of doctors that specialize in various areas of the body and health. The document outlines over 30 different types of doctors including cardiologists, dermatologists, neurologists, psychiatrists, surgeons, and more. Each doctor specializes in a specific area of the body or medical condition. Knowing the different types of doctors and their specializations can help choose the right doctor when needing medical care for a particular illness or condition.
The document summarizes the history and development of sleep medicine in Malaysia. It discusses the founding of the Sleep Disorders Society of Malaysia in 2001 with its objectives to foster research collaboration and education. It outlines the challenges in training technicians and doctors in sleep medicine. It also discusses future directions such as establishing clear policies, multi-disciplinary clinics, and large epidemiological studies to better understand sleep disorders in Malaysia.
This document outlines objectives and content for a chapter on airway management, ventilation, and oxygenation. It includes reviews of respiratory system anatomy and physiology, pathophysiology of respiratory issues, assessment of airway and breathing, and management of unresponsive patients. The objectives cover topics like airway anatomy, abnormal breath sounds, oxygen administration, and ventilation techniques.
This document discusses evidence for preventing ventilator-associated pneumonia (VAP) through appropriate oral care for mechanically ventilated patients in intensive care units. It reviews literature showing that VAP increases mortality and hospital stay. Chlorhexidine oral care is shown to be more effective at preventing VAP than tooth brushing alone, as it has bactericidal properties, while brushing only reduces bacteria. Studies also find developing VAP is associated with changes in oral health for intubated neuroscience ICU patients. The best practice for VAP prevention is a combined approach including chlorhexidine oral care along with other measures like head elevation and limiting hospital stay.
To hop 3 thao duoc co tac dung tuong tu corticoidNgoc Dang
This study compared the efficacy and safety of an antiasthma herbal medicine intervention (ASHMI) to prednisone for treating moderate-severe allergic asthma. In a double-blind randomized controlled trial, 91 adult asthma patients received either ASHMI capsules with prednisone placebo or prednisone tablets with ASHMI placebo for 4 weeks. Both treatments significantly improved lung function and reduced symptoms and IgE levels. However, prednisone further reduced TH2 cytokines and cortisol levels while ASHMI increased TH1 cytokines and cortisol levels. No severe side effects occurred with either treatment. The study suggests ASHMI is a safe and effective alternative asthma treatment to prednisone without adverse effects on adrenal
The document discusses different types of doctors and their specializations. It defines the differences between physicians and doctors, with doctors requiring more education and training including residencies. It then lists and defines various medical specializations like cardiologists, neurologists, orthopedic surgeons, and others. It also provides data on average yearly salaries for different doctor specializations, ranging from pediatricians and family medicine doctors earning around $156,000-165,000 to radiologists, orthopedic surgeons, and cardiologists among the lowest paid at around $309,000-315,000 and dermatologists and ophthalmologists among the highest paid at around $270,000-283,000.
Work–related Musculoskeletal Disorders Among Healthcare Workers in a General ...CSCJournals
Background. Musculoskeletal disorders is the most common disease among healthcare workers. Which affects not only the quality of life but also the income, the health, the economy. In Vietnam, there are some research about the MSDs among healthcare workers and the factors affect this problem, especially, the ergonomic factors. Objective. To assess the prevalence of musculoskeletal disorders among healthcare workers in Cao Bang General Provincial Hospital, Vietnam and determine risk factors associated with musculoskeletal disorders. Material and methods. A cross-sectional study was conducted among 85 healthcare workers in a general provincial hospital in Vietnam using the Nordic questionnaire and questionnaire. Results. High prevalence of musculoskeletal among healthcare workers during the past 12 months (62.4%) and last 7 days (45.9%), with the two most common sites being low back pain (48.2%) and neck (40%). Gender, work experience, total working hours, night shift work, and stress level showed the association with the MSDs in the past 12 months. Conclusion. Due to the high prevalence of MSDs among healthcare workers in a general provincial hospital, preventive actions are needed to improve the working conditions and to raise the awareness of healthcare workers about MSDs prevention.
Medical Students in Global Neurosurgery: Rationale and RoleAhmad Ozair
Approximately 5 million essential neurosurgical cases are unmet each year, all in low- and middle-income countries (1). After the Lancet Commission on Global Surgery described the absence of global surgery from global health discourse in January 2014 (2), the field of neurosurgery quickly recognized the importance of increasing equity in care globally (3-5). Although existing initiatives in global neurosurgery have focused on neurosurgeons and trainees, medical students represent a promising group for sustainable long-term engagement. We characterize why medical students are fundamental to success, outline the importance of incorporating medical students, and delineate how to increase medical student interest and participation in global neurosurgery.
Morbidity and Mortality in Patients with Difficult Tracheal Intubation: An Analysis of the PeDIR Registry
This study analyzed 900 cases of difficult direct laryngoscopy (DDL) in children from the Pediatric Difficult Intubation registry (PeDIR) to identify risk factors associated with complications. The overall complication rate was 22.7% and the severe complication rate was 2.6%. Multiple intubation attempts, intubation outside the operating room, and unanticipated difficult airways were associated with severe complications on multivariate analysis. The results indicate there is significant morbidity and mortality in pediatric patients with difficult direct laryngoscopy, and certain risk factors can help identify those at higher risk of severe complications.
Scope of Practice & Credentialling in Osteopathic Practice Stiofan Mac Suibhn...OCNZ
This document discusses the need for osteopathy in New Zealand to reform its scope of practice framework. It notes that the profession is maturing and diversifying, and the current scope does not adequately reflect this. It proposes introducing general, vocational and extended scopes of practice to recognize different levels of training and specialization. Specific vocational scopes discussed include gerontology, pain management and paediatrics. Formal postgraduate training requirements are recommended for entry to vocational scopes. This is intended to better guide career development, improve quality of care, and ensure competence in specialist areas of practice.
This document summarizes a study that assessed critical care nurses' knowledge of adult mechanical ventilation management at B.P. Koirala Institute of Health Sciences in Nepal. The study found that most nurses had adequate knowledge in areas like ventilation definitions, tracheotomy care, and acidosis management. However, knowledge was limited in less common areas like indications for CPR, laryngeal mask airway use, and continuous positive airway pressure. The study concluded regular continuing education is needed for ICU nurses to ensure optimal patient care given younger, less experienced staff and knowledge gaps identified.
Evaluation of Empirical Usage of Respiratory Medications in Treatment of Pati...DR. SUJOY MUKHERJEE
1) The study evaluated the empirical use of respiratory medications in 550 patients presenting with chronic lower respiratory symptoms who were referred for spirometric screening.
2) It was found that empirical usage of medications without spirometry was widespread, with the potential for future adverse outcomes from misdiagnoses.
3) The study concluded that all patients with chronic lower respiratory symptoms should have their diagnoses confirmed with spirometry testing before receiving medications to avoid incorrect diagnoses and unwanted side effects from unnecessary treatments.
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
This document summarizes the 2nd Clinical Research Open House held by the Fellowship and Residency Research Program (FRRP) at the American University of Beirut Medical Center. 46 graduating residents presented their research work in both oral presentations and posters. Several residents received awards for their presentations and posters. The event highlighted the research efforts of residents and the support provided by the FRRP and Clinical Research Institute.
This document provides an overview of toxicologic emergencies and poisonings. It defines key terms, describes common toxins and routes of exposure. It emphasizes the importance of scene safety, obtaining a thorough history, and monitoring for deterioration. It provides guidance on supportive care, activated charcoal administration, and contacting poison control. Specific toxins discussed include carbon monoxide, cyanide and caustic substances. The key objectives are to recognize toxicologic emergencies, initiate appropriate treatment and safely manage the patient.
This document summarizes a journal club presentation on a study evaluating changes in health-related quality of life (HRQOL) in brain tumor patients before and after surgery. The study assessed 258 patients using the EORTC QLQ-C30 and QLQ-BN20 questionnaires before and 3-6 months after surgery. After surgery, global QOL and emotional function improved significantly, while physical function declined. Larger tumor size, younger age, and lack of preoperative deficits were associated with poorer postoperative QOL. The study concluded that several factors influence HRQOL in brain tumor patients, and further research is needed to better understand long-term changes and ways to enhance QOL.
This study aimed to identify factors predicting stretching exercise (SE) behaviors among 420 office employees in Iran using the health promotion model (HPM). The study found that perceived self-efficacy, commitment to a plan of action, and interpersonal influences positively predicted SE, while perceived barriers to action negatively predicted SE. Employees who were more confident and committed to a plan, perceived fewer barriers, and had social support were more likely to engage in regular SE. This study identified important factors for designing interventions to promote SE behaviors for preventing musculoskeletal disorders in office employees.
Dr. Mahmud Alam Khan is a Nepalese cardiologist seeking a position where he can continue advancing his knowledge and skills in interventional cardiology. He has an MD in Cardiology from King Edward Medical University in Pakistan and over 10 years of experience in cardiology departments in Pakistan and Nepal, including as a senior registrar performing procedures independently. His skills include echocardiography, angiography, angioplasty and pacemaker insertion.
OCNZ Aug 2012 Regional Conference Scope of Practice ReformOCNZ
Stiofan Mac Suibhne presentation on the proposed scope of practice schema for the NZ osteopathic profession. Overview of the legislative framework and demographic changes driving the healthcare agenda.
This study examined the attitudes and treatment of 3,415 asthma patients in 11 countries who were prescribed regular maintenance therapy of inhaled corticosteroids. The study found that 74% used short-acting beta-agonists daily and 51% had uncontrolled asthma according to a questionnaire. Even patients with well-controlled asthma reported an average of 6 worsening episodes per year. While patients recognized the early signs of worsening, the most common response was to increase short-acting beta-agonist use rather than inhaled corticosteroids. This represents a missed opportunity to properly manage worsening asthma.
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
The headache under response to treatment (hurt) questionnaire- assessment of ...medicinadellecefalee
The document describes a study that assessed the reliability and responsiveness of the Headache Under-Response to Treatment (HURT) Questionnaire. The study administered the HURT questionnaire to 159 patients at headache specialist centers in three countries at three time points: before their initial visit, at the initial visit, and when the specialist felt the best possible treatment outcome had been achieved. The study found the HURT questionnaire had very good internal consistency and was responsive to treatment-induced changes, with significant improvements in scores post-intervention. However, it did not detect improvements in patients' concerns about medication side effects. The study concluded the HURT questionnaire is useful for assessing headache frequency, disability, medication use, and treatment outcomes across headache disorders.
Obstructive sleep apnea treatment in adults chang2019Ana M Vèlez Ochoa
This document provides a review of treatments for obstructive sleep apnea (OSA) in adults. It discusses the importance of properly diagnosing and evaluating the severity of OSA before initiating treatment. The most common OSA treatments discussed are continuous positive airway pressure (CPAP), oral appliances, weight loss interventions, positional therapy, and various surgical procedures. The review notes that while CPAP is often the preferred first-line treatment for moderate to severe OSA, adherence can be challenging, so alternative treatments are needed for patients who cannot tolerate CPAP. Overall, the review examines the benefits and limitations of different OSA treatment options.
Airway issues may be one of the last frontiers in health. As an afterthought airway issues are found to nearly always contribute to effective case management. Join us at this meeting March 2015.
The document discusses different types of doctors and their specializations. It defines the differences between physicians and doctors, with doctors requiring more education and training including residencies. It then lists and defines various medical specializations like cardiologists, neurologists, orthopedic surgeons, and others. It also provides data on average yearly salaries for different doctor specializations, ranging from pediatricians and family medicine doctors earning around $156,000-165,000 to radiologists, orthopedic surgeons, and cardiologists among the lowest paid at around $309,000-315,000 and dermatologists and ophthalmologists among the highest paid at around $270,000-283,000.
Work–related Musculoskeletal Disorders Among Healthcare Workers in a General ...CSCJournals
Background. Musculoskeletal disorders is the most common disease among healthcare workers. Which affects not only the quality of life but also the income, the health, the economy. In Vietnam, there are some research about the MSDs among healthcare workers and the factors affect this problem, especially, the ergonomic factors. Objective. To assess the prevalence of musculoskeletal disorders among healthcare workers in Cao Bang General Provincial Hospital, Vietnam and determine risk factors associated with musculoskeletal disorders. Material and methods. A cross-sectional study was conducted among 85 healthcare workers in a general provincial hospital in Vietnam using the Nordic questionnaire and questionnaire. Results. High prevalence of musculoskeletal among healthcare workers during the past 12 months (62.4%) and last 7 days (45.9%), with the two most common sites being low back pain (48.2%) and neck (40%). Gender, work experience, total working hours, night shift work, and stress level showed the association with the MSDs in the past 12 months. Conclusion. Due to the high prevalence of MSDs among healthcare workers in a general provincial hospital, preventive actions are needed to improve the working conditions and to raise the awareness of healthcare workers about MSDs prevention.
Medical Students in Global Neurosurgery: Rationale and RoleAhmad Ozair
Approximately 5 million essential neurosurgical cases are unmet each year, all in low- and middle-income countries (1). After the Lancet Commission on Global Surgery described the absence of global surgery from global health discourse in January 2014 (2), the field of neurosurgery quickly recognized the importance of increasing equity in care globally (3-5). Although existing initiatives in global neurosurgery have focused on neurosurgeons and trainees, medical students represent a promising group for sustainable long-term engagement. We characterize why medical students are fundamental to success, outline the importance of incorporating medical students, and delineate how to increase medical student interest and participation in global neurosurgery.
Morbidity and Mortality in Patients with Difficult Tracheal Intubation: An Analysis of the PeDIR Registry
This study analyzed 900 cases of difficult direct laryngoscopy (DDL) in children from the Pediatric Difficult Intubation registry (PeDIR) to identify risk factors associated with complications. The overall complication rate was 22.7% and the severe complication rate was 2.6%. Multiple intubation attempts, intubation outside the operating room, and unanticipated difficult airways were associated with severe complications on multivariate analysis. The results indicate there is significant morbidity and mortality in pediatric patients with difficult direct laryngoscopy, and certain risk factors can help identify those at higher risk of severe complications.
Scope of Practice & Credentialling in Osteopathic Practice Stiofan Mac Suibhn...OCNZ
This document discusses the need for osteopathy in New Zealand to reform its scope of practice framework. It notes that the profession is maturing and diversifying, and the current scope does not adequately reflect this. It proposes introducing general, vocational and extended scopes of practice to recognize different levels of training and specialization. Specific vocational scopes discussed include gerontology, pain management and paediatrics. Formal postgraduate training requirements are recommended for entry to vocational scopes. This is intended to better guide career development, improve quality of care, and ensure competence in specialist areas of practice.
This document summarizes a study that assessed critical care nurses' knowledge of adult mechanical ventilation management at B.P. Koirala Institute of Health Sciences in Nepal. The study found that most nurses had adequate knowledge in areas like ventilation definitions, tracheotomy care, and acidosis management. However, knowledge was limited in less common areas like indications for CPR, laryngeal mask airway use, and continuous positive airway pressure. The study concluded regular continuing education is needed for ICU nurses to ensure optimal patient care given younger, less experienced staff and knowledge gaps identified.
Evaluation of Empirical Usage of Respiratory Medications in Treatment of Pati...DR. SUJOY MUKHERJEE
1) The study evaluated the empirical use of respiratory medications in 550 patients presenting with chronic lower respiratory symptoms who were referred for spirometric screening.
2) It was found that empirical usage of medications without spirometry was widespread, with the potential for future adverse outcomes from misdiagnoses.
3) The study concluded that all patients with chronic lower respiratory symptoms should have their diagnoses confirmed with spirometry testing before receiving medications to avoid incorrect diagnoses and unwanted side effects from unnecessary treatments.
The effect of clonidine on peri operative neuromuscular blockade and recoveryAhmad Ozair
Background: Alpha-2-agonists are as used adjunct for anaesthesia. We conducted this study with the aim to determine whether the addition of clonidine, an α-2-agonist, decreases the time to recovery from neuromuscular blockade caused by non-depolarising muscle relaxant. Secondary objectives were to know whether clonidine as an adjuvant improves hemodynamic stability, decreases stress hyperglycaemia, pain and time to discharge from Post-Anaesthesia Care Unit (PACU). Methods: This placebo-controlled clinical trial, enrolled 64 patients into clonidine (n = 32) or placebo (saline) group (n = 32). Study drug was given 1.5 mcg/kg IV bolus at the time of induction followed by infusion (1.5 mcg/kg/hour) intra-operatively. Extubation was started when train-of-four (TOF) count was ≥ 2. Primary outcome measure was time to achieve TOF ratio of ≥ 70% and ≥ 90%, assessed at 5, 15, 30- and 60-min intervals following extubation. Results: 2 patients in each group were excluded due to intra-operative requirement of additional supportive medications, hence in each group 30 were analysed. Significant difference was observed between clonidine and placebo groups in terms of time to achieve TOF ratio ≥ 70% and ≥ 90%, stress hyperglycemia, hemodynamic and pain profile, no statistical difference in the Ramsey sedation score and modified Aldrete score between groups. Patients given clonidine required repeat doses of non-depolarising muscle relaxant at longer intervals, with decrease in total amount administered. Clonidine group had a median time to achieve TOF ratio ≥ 70% at 15 min compared to 60 min in placebo group. Conclusion: Clonidine hastens the recovery from neuromuscular block with reduced stress hyperglycaemia and post-operative pain, along with unaffected Ramsey sedation score and modified Aldrete score.
This document summarizes the 2nd Clinical Research Open House held by the Fellowship and Residency Research Program (FRRP) at the American University of Beirut Medical Center. 46 graduating residents presented their research work in both oral presentations and posters. Several residents received awards for their presentations and posters. The event highlighted the research efforts of residents and the support provided by the FRRP and Clinical Research Institute.
This document provides an overview of toxicologic emergencies and poisonings. It defines key terms, describes common toxins and routes of exposure. It emphasizes the importance of scene safety, obtaining a thorough history, and monitoring for deterioration. It provides guidance on supportive care, activated charcoal administration, and contacting poison control. Specific toxins discussed include carbon monoxide, cyanide and caustic substances. The key objectives are to recognize toxicologic emergencies, initiate appropriate treatment and safely manage the patient.
This document summarizes a journal club presentation on a study evaluating changes in health-related quality of life (HRQOL) in brain tumor patients before and after surgery. The study assessed 258 patients using the EORTC QLQ-C30 and QLQ-BN20 questionnaires before and 3-6 months after surgery. After surgery, global QOL and emotional function improved significantly, while physical function declined. Larger tumor size, younger age, and lack of preoperative deficits were associated with poorer postoperative QOL. The study concluded that several factors influence HRQOL in brain tumor patients, and further research is needed to better understand long-term changes and ways to enhance QOL.
This study aimed to identify factors predicting stretching exercise (SE) behaviors among 420 office employees in Iran using the health promotion model (HPM). The study found that perceived self-efficacy, commitment to a plan of action, and interpersonal influences positively predicted SE, while perceived barriers to action negatively predicted SE. Employees who were more confident and committed to a plan, perceived fewer barriers, and had social support were more likely to engage in regular SE. This study identified important factors for designing interventions to promote SE behaviors for preventing musculoskeletal disorders in office employees.
Dr. Mahmud Alam Khan is a Nepalese cardiologist seeking a position where he can continue advancing his knowledge and skills in interventional cardiology. He has an MD in Cardiology from King Edward Medical University in Pakistan and over 10 years of experience in cardiology departments in Pakistan and Nepal, including as a senior registrar performing procedures independently. His skills include echocardiography, angiography, angioplasty and pacemaker insertion.
OCNZ Aug 2012 Regional Conference Scope of Practice ReformOCNZ
Stiofan Mac Suibhne presentation on the proposed scope of practice schema for the NZ osteopathic profession. Overview of the legislative framework and demographic changes driving the healthcare agenda.
This study examined the attitudes and treatment of 3,415 asthma patients in 11 countries who were prescribed regular maintenance therapy of inhaled corticosteroids. The study found that 74% used short-acting beta-agonists daily and 51% had uncontrolled asthma according to a questionnaire. Even patients with well-controlled asthma reported an average of 6 worsening episodes per year. While patients recognized the early signs of worsening, the most common response was to increase short-acting beta-agonist use rather than inhaled corticosteroids. This represents a missed opportunity to properly manage worsening asthma.
This document summarizes and discusses several articles on physical medicine and rehabilitation (PMR) topics that were published in recent issues of various journals. The articles cover a range of topics including the treatment of 12th rib syndrome, the use of the tourniquet ischemia test to diagnose complex regional pain syndrome, physiotherapy interventions for treating spasticity, a telehealth intervention to increase fitness for those with spinal cord injuries, spinal cord involvement in COVID-19, the use of local anesthetic injections in athletes, and a comparison of video-based and text-based physical activity interventions. The document also provides an introduction and welcome from the editor as well as information about new contributors.
The headache under response to treatment (hurt) questionnaire- assessment of ...medicinadellecefalee
The document describes a study that assessed the reliability and responsiveness of the Headache Under-Response to Treatment (HURT) Questionnaire. The study administered the HURT questionnaire to 159 patients at headache specialist centers in three countries at three time points: before their initial visit, at the initial visit, and when the specialist felt the best possible treatment outcome had been achieved. The study found the HURT questionnaire had very good internal consistency and was responsive to treatment-induced changes, with significant improvements in scores post-intervention. However, it did not detect improvements in patients' concerns about medication side effects. The study concluded the HURT questionnaire is useful for assessing headache frequency, disability, medication use, and treatment outcomes across headache disorders.
Obstructive sleep apnea treatment in adults chang2019Ana M Vèlez Ochoa
This document provides a review of treatments for obstructive sleep apnea (OSA) in adults. It discusses the importance of properly diagnosing and evaluating the severity of OSA before initiating treatment. The most common OSA treatments discussed are continuous positive airway pressure (CPAP), oral appliances, weight loss interventions, positional therapy, and various surgical procedures. The review notes that while CPAP is often the preferred first-line treatment for moderate to severe OSA, adherence can be challenging, so alternative treatments are needed for patients who cannot tolerate CPAP. Overall, the review examines the benefits and limitations of different OSA treatment options.
Airway issues may be one of the last frontiers in health. As an afterthought airway issues are found to nearly always contribute to effective case management. Join us at this meeting March 2015.
This document describes a study protocol to evaluate the effectiveness of a planned teaching program for preventing pressure ulcers among fracture patients in a selected hospital in Bangalore. The study aims to provide patients and their family members with health education to improve knowledge on preventing pressure ulcers. A literature review found that pressure ulcer incidence is high for immobile patients like those with orthopedic fractures. Studies show prevention is better than treatment and nurses play a key role in educating patients and monitoring skin integrity. The planned teaching program aims to reduce pressure ulcer rates by empowering patients with knowledge on prevention.
Prevention perspective in orthodontics and dento facial orthopedicsAhlam Alkhubani
The document discusses prevention perspectives in orthodontics and dentofacial orthopedics. It outlines three levels of prevention - primordial, primary, and secondary. The document examines various environmental factors that can influence malocclusion development, including diet/mastication, breathing, swallowing, and oral habits. Maintaining a solid diet and preventing oral breathing, tongue thrusting, and non-nutritive sucking can help facilitate proper jaw development and prevent malocclusions. Early identification and intervention of environmental risk factors is key to orthodontic prevention.
OIA Texas 2014 Keynote Emma Fairs OCNZ @OsteoRegulationOCNZ
The Osteopathic Council of New Zealand is the statutory regulatory authority for the NZ profession and is responsible for determining scopes of practice and developing competencies frameworks.
This document provides guidance for a practical class on anesthesia for trauma patients. It begins with an overview of the importance of trauma anesthesia and discusses the initial assessment of trauma patients through a primary survey examining airway, breathing, circulation, disability and exposure. It provides details on establishing the airway for trauma patients while protecting the cervical spine, and assessing breathing and circulation. The document outlines the contents to be covered in the practical class, including anesthesia considerations for different types of trauma injuries.
This document provides a clinical practice guideline for managing otitis media with effusion (OME), which is fluid in the middle ear without signs of acute ear infection. It is an update of a 2004 guideline. Key changes include adding consumer advocates, incorporating new evidence from clinical practice guidelines and studies, emphasizing patient education and shared decision making, and new/expanded recommendations regarding diagnosis, management of chronic/at-risk cases, and assessing outcomes of OME resolution or improved hearing/quality of life. The guideline provides 11 action statements with strong or recommended approaches to diagnosing and managing OME in children ages 2 months to 12 years.
This document provides an overview of obstructive sleep apnea (OSA), including its causes, symptoms, diagnosis, and management options. It discusses that OSA is characterized by repetitive collapse of the upper airway during sleep, disrupting breathing. Risk factors include obesity, male gender, age, and craniofacial abnormalities. Diagnosis involves questionnaires, physical exams, and polysomnography. Treatment includes positive airway pressure and oral appliances, which work by advancing the mandible to open the airway. Oral appliances effectively treat mild to moderate OSA and reduce snoring but have side effects like teeth pain that require follow-up.
This document discusses airway management of pediatric trauma patients. It begins by outlining the anatomical and physiological differences between pediatric and adult airways that make management more challenging in children. These include a larger head, prominent occiput, large tongue, and smaller, more collapsible airways. It then covers assessing the airway, preparing appropriate equipment, performing basic airway maneuvers like positioning and airway adjuncts, and considerations for more definitive techniques like bag-mask ventilation and endotracheal intubation in trauma scenarios. Key steps in pediatric airway management and selecting the proper equipment size are emphasized.
Optometric vision therapy aims to treat nonstrabismic accommodative and vergence disorders through sensory-motor-perceptual stimulation paradigms. It incorporates controlled manipulation of blur, disparity, and proximity to normalize the accommodative and vergence systems. Cure rates for these disorders are high, ranging from 70-100%, through optometric vision therapy. The article discusses the scientific basis and models of accommodation and vergence, and reviews studies showing objective changes in oculomotor responsiveness following vision therapy, supporting its efficacy.
Optometric vision therapy aims to treat nonstrabismic accommodative and vergence disorders through sensory-motor-perceptual stimulation paradigms. It incorporates controlled manipulation of blur, disparity, and proximity to normalize the accommodative and vergence systems. Cure rates for these disorders are high, ranging from 70-100%, through optometric vision therapy. The article discusses the scientific basis and models of accommodation and vergence, and reviews studies showing objective changes in oculomotor responsiveness following vision therapy, supporting its efficacy.
Contents lists available at ScienceDirectInternational JouAlleneMcclendon878
Contents lists available at ScienceDirect
International Journal of Orthopaedic and Trauma Nursing
journal homepage: www.elsevier.com/locate/ijotn
Prevention of heel pressure ulcers among adult patients in orthopaedic
wards: an evidence-based implementation project
Siew Yi Koha, Hui Ling Yeoa, Mien Li Gohb,∗
aUniversity of Orthopaedic Cluster, National University Hospital, Singapore
b Evidence Based Nursing Unit, National University Hospital, Singapore
A B S T R A C T
Background: Immobility and prolonged bed rest often lead to heel pressure ulcers in patients. A point prevalence audit undertaken in the orthopaedic wards of a
Singapore tertiary hospital reported that 6 out of 30 patients who were audited had mild to blanching redness on their heels.
Aims: The evidence-based project sought to achieve 80% compliance from nurses to perform heel off-loading practice and a 50% reduction in the occurrence of heel
pressure ulcers.
Methods: The project, lasting two years, was undertaken in two orthopaedic wards and utilized a pre- and post-implementation audit strategy using the Joanna Briggs
Institute on-line 'Practical Application of Clinical Evidence System' and 'Getting Research into Practice' programs. Implementation occurred in four phases and
involved a sample consisting of 30 adult patients.
Results: Nurses’ compliance with performing heel off-loading techniques increased. The post-implementation audit showed 93.3% compliance of nurses undertaking
heel off-loading techniques in the subsequent four follow-up audits. Meanwhile, the compliance with documentation increased from 63.3% to 86.7%. The project
resulted in more than 50% reduction in stage one heel pressure ulcers.
Conclusion: The implementation of heel off-loading techniques significantly reduced the incidences of heel pressure ulcers in orthopaedic wards.
Background
Pressure ulcers are a common and perpetual problem in healthcare
settings worldwide (Corbett et al., 2017). Pressure ulcers (PUs), also
known as pressure injury or bed sores, are areas of necrotic soft tissue,
that usually occur over bony prominences (Ministry of Health [MOH]
Nursing Clinical Practice Guidelines, 2001; Sussman and Bates-Jensen,
2007; Smeltzer et al., 2010). They usually develop when skin is sub-
jected to shear, friction and prolonged unrelieved pressure. Many areas
in the human anatomy are susceptible to PUs, for instance occiput,
sacrum, elbow and heel (Smeltzer et al., 2010).
There are six classifications of PUs (National Pressure Ulcer
Advisory Panel, European Pressure Ulcer Advisory Panel, & Pan
Pacific Pressure Injury Alliance, 2014). Stage one PU presents as
non-blanching discoloration of intact skin, often in red, blue or
purplish hues. Stage two PUs involve partial thickness loss of
dermis with a shallow wound or intact blister. An ulcer progresses
to stage three when there is full thickness tissue loss, accompanied
by undermining or tunneling. Full thickness tissue loss with ex-
posed bone ...
Obstructive Sleep Apnea Syndrome (OSAS) is highly prevalent
in patients with acromegaly; due to craniofacial deformations and enlargement of pharyngeal soft tissue. Although the obstructive. type was the prevailing type, there are some reports suggesting an association between Acromegaly and Central Sleep Apnea Syndrome (CSAS) and hypotheses that elevation in the GH level may cause a defect in the respiratory drive. Hence, the presented clinil case discusses key considerations for diagnosis of sleep apnea syndrome in patient with acromegaly.
This document describes a retrospective study conducted at a tertiary care center that analyzed data on cases of osteomyelitis from 2006 to 2016. The study found that the number of female patients was equal to male patients, and most patients were between 30-45 years old. Unlike typical presentations where the mandible is more commonly affected, this study found that the maxilla was more commonly involved than the mandible. The posterior region of the maxilla was more frequently affected than the anterior region. The study aims to help optimize local treatment protocols by assessing epidemiological data from this specific tertiary care center.
Occupational hazards are common in the field of dentistry. Dentists face a variety of biological, physical, ergonomic, and psychological hazards. Biological hazards, like exposure to Hepatitis B and HIV, pose serious risks due to the potential for transmission through needle sticks or contact with blood and saliva. Dentists have a higher risk of contracting certain infections compared to the general population. Other common occupational hazards for dentists include musculoskeletal problems, noise exposure, radiation exposure, allergic reactions, and job-related stress. Proper training, immunization, and safety precautions are needed to help protect dental workers from the various occupational health risks they may encounter.
To Study the Impact of Yoga on Pulmonary Functions, Immune Response and Quali...semualkaira
Trauma is an everyday event which is natural and widespread in the modern era. It is the leading cause of mortality and morbidity, especially during the productive age and has been projected to be the third most common cause of death by 2010.
Trauma is a major cause of chest injury around the world. In developed nations, trauma usually occurs as a result of industrial accidents, farming accidents, or motor vehicle accidents, which include automobiles, motorcycles and trains.
To Study the Impact of Yoga on Pulmonary Functions, Immune Response and Quali...semualkaira
Trauma is an everyday event which is natural and widespread in
the modern era. It is the leading cause of mortality and morbidity,
especially during the productive age and has been projected to be
the third most common cause of death by 2010.
To Study the Impact of Yoga on Pulmonary Functions, Immune Response and Quali...semualkaira
Trauma is an everyday event which is natural and widespread in
the modern era. It is the leading cause of mortality and morbidity,
especially during the productive age and has been projected to be
the third most common cause of death by 2010.
Similar to role of oral health professional in pediatric obstructive sleep apnea (20)
Congenital absence of maxillary lateral incisors is a frequent clinical challenge which must be solved by a multidisciplinary approach in order to obtain an
esthetic and functional restorative treatment. . Fixed prosthodontic and removable prostheses, resin bonded retainers, orthodontic movement of maxillary
canine to the lateral incisor site and single tooth implants represent the available treatment modalities to replace congenitally missing teeth. This case report
demonstrates the team approach in prosthetic and surgical considerations and techniques for managing the lack of lateral incisors. The aims of this case
report of replacement of bilaterally congenitally missing maxillary lateral incisors with dental implants.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations.
Impacted Maxillary Central Incisors: Surgical Exposure and Orthodontic Treat...Abu-Hussein Muhamad
The maxillary permanent central incisor develops early in life and forms part of an aesthetic smile. Disruption of the formation or eruption of the permanent
central incisor has multiple etiological factors. Treatment options depend to some extent on the cause of failure of eruption of the central incisor. Generally,
the earlier treatment is provided, the higher the likelihood of success and the less the complexity. Our results suggest that close monitoring and interdisciplinary
cooperation during the treatment phases led to a successful esthetic result, with good periodontal health and functional occlusion.
Excess of space in the dental arch is diagnosed as a
generalised spacing or a local divergence, often
observed in the maxillary anterior region, as a median
diastema, traumatic loss of central incisors, or
congenital absence of lateral incisors. Furthermore,
spacing is observed in aging individuals, due to
pathological migration of teeth caused by
periodontitis. Finally, adult individuals with partial
edentulous jaws demand pre-prosthetic orthodontic
treatment from functional aspects. Thus, indication for
orthodontic treatment in subjects with spacing of teeth
exists for aesthetic reasons, but also for facilitating
prosthetic restorations with optimal occlusalstability.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting
cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically
induced failures, since low primary implant stability, low bone density, short implants and overload have been
identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a
successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field.
This document provides guidance on how to write and publish a scientific paper in 3 steps:
1. Plan adequate time for writing a high-quality paper that will be accepted for publication. Previous studies show lack of time is the top reason papers are not published.
2. Carefully review the instructions for authors on the target journal's website and adhere strictly to formatting requirements. Ignoring guidelines is a common reason for rejection.
3. The paper should have key sections - an informative abstract, introduction establishing the study's purpose and novelty, thorough methods section, clear results, and conclusions tying it all together. Following best practices increases the chances of successful publication.
Aesthetic Management of Fractured Anteriors: A Case ReportAbu-Hussein Muhamad
Introduction: Coronal fracture of anterior teeth is an important topic for esthetic dentistry. Such fractures may jeopardize esthetics, function, tissue biology
and occlusal physiology, thus endangering tooth vitality and integrity. Coronal fractures resulting from dental trauma most frequently occur to the maxillary
anterior teeth of adolescents and less frequently to mandibular teeth. Adult teeth may also suffer traumatic fracture, although less frequently than for
adolescents.
Case Report: In our case, an economical and time-saving novel technique has been described for direct composite restoration in a young patient with
uncomplicated fractured maxillary anterior tooth.
Conclusion: As restoring a fractured tooth is a complex procedure, this technique can prove as a simple, effective and appropriate technique that will fulfill all
the requirements of dental personnel. This technique can also prove to be easy for inexperienced beginner clinicians without requiring special skills in
providing the patients with direct composite restorations
Orthodontic tooth movement is basically a biologic response towards a mechanical force. Osteoclast and osteoblast cells mediate bone resorption and apposition, which eventually produces tooth movement. Researches showed that the rate of orthodontic tooth movement can be altered by certain drugs locally or systemically. The Objective of this article is to discuss the current data concerning the effect of drugs on orthodontic tooth movement.
Multidisciplinary Approach in the Rehabilitation of Congenitally Maxillary C...Abu-Hussein Muhamad
Objective: This case report describes the multidisciplinary
approach to treat a congenitally missed maxillary canine, how to
improve patient’s smile using orthodontic fixed appliance, endosseous
dental implant, and porcelain veneer to achieve the treatment results of
function and esthetic.
Materials and procedures: Unilateral agenesis of the permanent
maxillary canines in healthy individuals is extremely rare. This
paper presents the case of a female patient diagnosed with congenital
unilateral agenesis of the permanent maxillary canines as well as
occlusal abnormalities in the form of left-side crossbite. To restore the
proper aesthetics and function, interdisciplinary therapeutic treatment
was implemented. In the case presented in this paper, the aim of
oral rehabilitation was to restore a functional balance by obtaining
proper skeletal relationships, creating optimal occlusal conditions and
obtaining arch continuity.
Conclusion: Interdisciplinary treatment combined of orthodontics,
implant surgery, and prosthodontics was useful to treat a nonsyndromic
oligodontia patient. Especially, with the new strategy, implantanchored
orthodontics, which can facilitate the treatmentand make it
more simply with greater predictability.
The multifactorial factors influenc cleft Lip-literature review Abu-Hussein Muhamad
Congenital cleft-Lip and cleft palate have been the subject of many genetic
studies, but until recently there has been no consensus as to their modes of
inheritance. In fact, claims have been made for just about every genetic
mechanism one can think of. Recently, however, evidence has been
accumulating that favors a multifactorial basis for these malformations. The
purpose of the present paper is to present the etiology of cleft lip and cleft palate
both the genetic and the environmental factors. It is suggested that the genetic
basis for diverse kinds of common or uncommon congenital malformations may
very well be homogeneous, whilst, at the same, the environmental basis is
heterogeneous.
Dental implants represent one of the most successful treatment modalities in dentistry.
However, failures do occur in the range from 5 to 8% for routine procedures and up to 20% in major grafting cases after at least 5 years of function . The majority of implant losses may be explained as biomechanically induced failures, since low primary implant stability, low bone density, short implants and overload have been identified as risk factors . Hence, achievement and maintenance of implant stability are pre-conditions for a successful clinical outcome with dental implants.
The review focuses on different methods used to assess implant stability and recent advances in this field
Over time, progressively shorter implants have been placed such that short implants are now available that are less than 6 mm in length. The viability and high success rates seen with short implants can be explained by osseointegration, the macro geometric design of the implant, as well as physics and the distribution of forces. This paper was aimed to review the stability and survival rate of short implants under functional loads. Numerical and clinical studies were reviewed. Keywords: Short dental implants, sinus augmentation, factors affecting bone regeneration in dental implantology
Porcelain laminate veneers are among the most esthetic means of creating a more pleasing and beautiful smile. Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation, approximately 0.5 mm to 0.7mm of surface enamel reduction. This study describes the use of ceramic veneers without tooth wear, reinforcing the concept that minimally invasive porcelain laminate veneers could become versatile and conservative allies in the fi eld of esthetic dentistry. Keywords: Ceramics, dentin-bonding agents, esthetics
Immediate Restoration of Single Implants Replacing Lateral Incisor Compromis...Abu-Hussein Muhamad
Today, the diagnosis of internal root resorption is significantly improved by the three-dimensional imaging. Furthermore, the CBCT’s superior diagnosis accuracy resulted in an improved management of the resorptive defects and a better outcome of Implant therapy of teeth with internal resorption.Implant has become a wide option to maintain periodontal architecture. Diagnosis and treatment planning is the key factors in achieving the successful outcomes after placing and restoring implants placed immediately after tooth extraction. The purpose of this clinical update is to report on the success and survival of Immediate restoration of single implants replacing right lateral incisor compromised by internal resorption.
Immediate Implant Placement And Restoration With Natural Tooth In The Maxilla...Abu-Hussein Muhamad
Anterior tooth loss and restoration in the esthetic zone is a common challenge in dentistry today. The prominent visibility of the area can be especially distressing to the patient and requires a timely and esthetically pleasing solution. Immediate single-tooth implantation followed by immediate provisionalization is becoming an increasingly desirable treatment that offers numerous benefits over conventional delayed loading. Provisionalization for immediately-placed implants using the patient’s existing tooth can enhance the final aesthetic outcome if certain steps are
followed. If the natural tooth is intact and can be used as a provisional, the emergence profile can be very similar to the preoperative condition. This article outlines a technique to use the patient’s natural tooth after extraction to provisionalize an implant.
Clinical Management of Bilateral Impacted Maxillary CaninesAbu-Hussein Muhamad
Introduction: Impaction of maxillary canines is a frequently encountered clinical problem in orthodontic therapy. When a preventive
approach fails, treatment involves surgical exposure of the impacted tooth, followed by orthodontic traction to guide and align it into the
dental arch. The aim of the present report was to demonstrate by case reports of an adult patient with bilateral impacted maxillary canines
treated with surgical exposure and orthodontic treatment.
Material and Methods: A 15year-old female with various degrees of bilateral palatal impaction of maxillary canines were managed
by the described technique.
Results and Discussion: Autonomous eruption of the impacted canines after surgical uncovering was witnessed in all patients
without the need for application of a vertical orthodontic force for their extrusion.
Conclusion: The described method of surgical uncovering and autonomous eruption created conditions for biological eruption of the
palatally impacted canines into the oral cavity and facilitated considerably the subsequent orthodontic treatment for their proper alignment
in the dental arch.
Keywords: Impacted canines; Surgical; Tooth exposure; Orthodontic treatment
“One-Piece” Immediate-Load Post-Extraction Implant In Maxillary Central IncisorAbu-Hussein Muhamad
Abstract: This case report describes extraction of a fractured left maxillary central incisor tooth, followed by immediate placement of an one-piece implant in the prepared socket and temporization by a bonded restoration.
Materials And Methods: The tooth was extracted with minimal hard and soft tissue trauma and without flap reflection. The socket was prepared to the required depth and a Implant was inserted.
Results: The atraumatic operating technique and the immediate insertion of the one-piece Implant resulted in the preservation of the hard and soft tissues at the extraction site.
Conclusion: The “One-piece” dental implant and provisional restoration provided the patient with immediate esthetics, function, comfort and most importantly preservation of tissues. The one-piece implant design resulted in a high cumulative implant survival rate and beneficial marginal bone levels.
Single Visit Replacement of Central Maxillary Using Fiber-Reinforced Composi...Abu-Hussein Muhamad
Fiber reinforced composites are high strength filling materials composed of conventional composites and glass fibres. They exhibit extensive applications in different fields of dentistry. This clinical report present a case where FRC technology was successfully used to restore central maxillary incisor edentulous area in terms of esthetic-cosmetic values and functionality.
Zirconium Dental Implants And Crown for Congenitally Missing Maxillary Latera...Abu-Hussein Muhamad
Zirconia implants were familiarized into dental implantology. Zirconia appears
to be an appropriate implant material due to its low plaque affinity, tooth like color, biocompatibility and mechanical properties. The following a case presentations will show how the acid-etched zirconia Implant can be used to functionally and aesthetically replace congenitally missing left lateral incisor tooth germ in the maxilla, and achieve optimal soft tissues and health.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
District Residency Programme (DRP) for PGs in India.pptx
role of oral health professional in pediatric obstructive sleep apnea
1. Asian Pac. J. Health Sci., 2014; 1(4): 528-538 e-ISSN: 2349-0659, p-ISSN: 2350-0964
____________________________________________________________________________________________________________________________________________
Role of oral health professional in pediatric obstructive sleep apnea
Abu-Hussein Muhamad1*, Abdulgani Azzaldeen2, Watted Nezar3, Kassem Firas4
1Department of Pediatic Dentistry, Athens, Greece
2Department of Conservative Dentistry, Al-Quds University, Jerusalem, Palestine
3Center of Dentistry & Esthetics, Jatt, Israel
4Department of Otolaryngology, Head and Neck Surgery, Meir Medical Center, Sackler and Faculty of Medicine,
Tel Aviv University, Israel
ABSTRACT
Obstructive sleep apnea is a sleep disorder of airflow at the nose and mouth during sleep. Patients with undiagnosed
sleep apnea represent a major public health problem. Dental professionals have a unique doctor patient relationship
that can help them in recognizing the sleep disorder and co-managing the patients along with a physician or a sleep
specialist. Oral appliance therapy is an important treatment modality for sleep apnea patients. This article discusses
the etiology, clinical features, diagnosis and various treatment options with special reference to oral appliances used
for obstructive sleep apnea.
Key words: Snoring, Obstructive Sleep Apnea (OSA), Oral appliance therapy
Introduction
The dentist plays an important role in sleep medicine by
examining patients during their annual or biannual dental
checkup for the risk of sleep-disordered breathing.
Patients reporting snoring, sleepiness, and morning
headaches in the presence of obesity, large tonsils, and/or
dental malformation (eg, retrognathia, deep palate, large
tongue) need to be guided by dentists to see their
otorhinolaryngologist, respiratory-pulmonologist, or
physician, as well as a sleep medicine expert. To manage
the sound and tooth damage or pain generated by
bruxism, oral appliances can be used, but the dentist
needs to understand when such an appliance is indicated
and the risks associated with its use. In cases where
surgery is indicated, maxillofacial surgeons or
otorhinolaryngologists collaborate closely with dentists
to provide treatment.[1-4]
_______________________________
*Correspondence
Abu-Hussein Muhamad
Department of Pediatic Dentistry,
Athens, Greece
E-mail: abuhusseinmuhamad@gmail.com
Dentists caring for patients with chronic orofacial pain
conditions (such as TMDs) also need to understand basic
sleep hygiene principles and to know when to refer
patients with chronic or intractable insomnia for
behavioral sleep medicine evaluation. Behavioral
treatments for chronic insomnia are considered first-line
interventions over pharmacologic treatment
options.A subset of chronic orofacial pain patients
presents with a complex psychologic overlay that
contributes to their ongoing pain and disability, a
combination that can be managed by sleep psychologists
working in conjunction with the interdisciplinary team[5-
7].
Sleep apnoea in infants was first described in 1975 in
relation to sudden infant death syndrome and obstructive
sleep apnoea (OSA) was described in 1976 in school
children[1]. Since then there has been a significant
increase in the recognition of sleep disorders in children.
Despite this, there is still a paucity of data on this
problem in children and also a lack of training of medical
professionals to address the issue. The long term
neurocognitive, metabolic and cardiovascular
complications and ability to prevent these with early
treatment warrant early diagnosis [8].
Sleep disordered breathing (SDB) encompasses osa and
upper airway resistance syndrome (UARS). OSA is
defined as a disorder of breathing during sleep
characterized by prolonged partial upper airway
obstruction, intermittent complete or partial obstruction
(obstructive apnoea or hypopnoea) or both prolonged
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Muhamad et al ASIAN PACIFIC JOURNAL OF HEALTH SCIENCES, 2014; 1(4): 528-538
www.apjhs.com 528
2. Asian Pac. J. Health Sci., 2014; 1(4): 528-538 e-ISSN: 2349-0659, p-ISSN: 2350-0964
____________________________________________________________________________________________________________________________________________
and intermittent obstruction that disrupt normal
ventilation during sleep, normal sleep patterns or both . It
is agreed that an apnoea-hypopnoea index greater than 1
is abnormal in a child. The International Classification of
Sleep Disorders 2nd edition (ICSD 2) defines apnoea as
a cessation of airflow over two or more respiratory
cycles[Table-1]. A specific time in seconds is not
applicable to children as normal respirations vary from
12 breaths per minute in an adolescent up to 60 breaths
per minute in a newborn. The definition of hypopnoea is
more variable across sleep centers; however most agree
that a reduction in airflow of at least 30 per cent is
required with or without an arousal and/or oxygen
desaturation of 3-4 per cent. UARS has more subtle
indications on polysomnography, with increased effort of
breathing (measured by increased negative intrathoracic
pressure) often leading to an arousal being more
prominent than apnoeas/hypopnoeas.
This article reviews, SDB in children with common
symptomatic presentations, and currently accepted
treatment options[9-12].
Table-1: Schematic diagram underlying the sympathetic nerve system activation associated with obstructive
sleep apnea syndrome that may lead to increased cardiovascular disease risk
Epidemiology
No definitive population-based study has evaluated the
presence of OSAS in children. Previous studies were
performed in different settings and implemented a
variety of tools. Some considered regular nocturnal
snoring a marker of chronic obstructive breathing during
sleep. The percentage
of individuals younger than 18 years who have been
reported with regular heavy snoring oscillated between
8% and 12%. Subjects in other studies underwent
polygraphic monitoring, but these studies were limited in
terms of sample size and testing difficulties; initial
studies estimated OSAS prevalence to be between1%and
3%. More recently, many specialists have estimated
OSAS prevalence to be between 5% and 6%. Although
better monitoring techniques during polysomnography
(PSG) have shown that more abnormal breathing events
are present, the definitive data are still lacking.[1,5,6,7]
Pathophysiology of OSA
The pathophysiology of OSA includes factors related to
upper airway anatomy, upper airway resistance and
upper airway muscle function during sleep. Upper
airway anatomy varies considerably among patients, so
that no single finding is pathognomonic of obstructive
apnea. However, narrowing of the upper airway is
commonly observed, especially at the level of the soft
palate and the base of the tongue [3]. Cephalometric
variants of the facial skeleton have been described,
including a relative retrognathia and a low position of the
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hyoid bone. Soft tissue changes include a decrease in the
posterior airway space, an increase in tongue volume
and, in some cases, pathologic enlargement of the
palatine or adenoidal tonsils [Fig.1-2]
Upper airway resistance is relatively increased in sleep
apnea patients. The resulting more negative inspiratory
pressure is thought to be an important factor in airway
collapse and obstruction. Increased airway compliance
may also contribute to airway collapse in apnea patients.
Inspiratory excitation of upper airway muscles maintains
patency when awake. Excessive relaxation or loss of
compensatory excitation of upper airway muscles
explains the propensity to collapse during sleep[1,5,9].
Figure 1: Massive tonsils could obstruct airway
Figure 2: Blocked airway in OSA
Diagnosis of OSA
Diagnosis of snoring and OSA should be based on
subjective and objective evaluations. Subjective
evaluation primarily includes snoring during sleep and
sleepiness during the day in adults. Confirmation of
existence and further monitoring of these symptoms can
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be achieved by using different questionnaires such as the
Epworth Sleepiness Scale (ESS).
In addition, the presence of obesity, decreased ability in
mental concentration, headaches, and morning mouth
dryness are also important parameters that help to
establish the correct diagnosis. Polysomnography (PSG)
is the best method to monitor and diagnose sleep apnea
and other sleep-disordered breathing problems[6-8]. PSG
is a comprehensive recording of the biophysiologic
changes that occur during sleep. It is usually preformed
in a sleep laboratory or the patient’s home using a
portable device. PSGs are usually performed using four
to eight channels measuring the nasal airflow, thoracic
eff ort channels, electrocardiography (ECG), pulse
oximetry.electroencephalography(EEG),electrooculograp
hy (EOG), electromyography (EMG), sleep positioning,
and leg movements. The main outcome of a PSG test is
the AHI, which represents the sleep apnea severity and
reflects the average number of apnea (complete cessation
in air flow) and hypopnea (partial cessation in air flow)
per hour of sleep. Newer tests provide similar
information by measuring alterations in autonomic
nervous system using a hand glove [9,11,12].
The severity of OSA is classified by the American Sleep
Disorder Association (1999) 24 on the basis of patient’s
AHI into the following categories.
These criteria are different for children:
• Mild OSA, 1 to 5 AHI
• Moderate OSA, 5 to 10 AHI
• Severe OSA, more than 10 AHI.
Risk factors for OSA are well known and include high
body mass index (BMI), age, male
gender,smoking,craniofacial anomalies like micrognathia
and retrognathia[1,3,7,10]. Alcohol consumption,
enlarged palatine tonsils, enlarged uvula, high-arched
palate, nasal septum deviation, inferiorly displaced hyoid
bone, disproportionately large tongue, a long soft palate,
and general decreased posterior airway space[11-12].
During the daytime, neurobehavioural symptoms such as
irritability, behavioural problems, and poor concentration
predominate. These result not only from hypoxia but also
from sleep fragmentation[18]. In experimental models
hypoxia has resulted in neuronal cell loss, which has
detrimental effects on memory and cognition. A review
identified studies that compared children with
obstructive sleep apnoea with controls using tools such
as the child behaviour checklist, Conners’ rating scale,
and the child health questionnaire[19]. Although the
studies provided a low standard of evidence, they
showed almost universally poorer concentration,
attention, behaviour, and quality of life in the group with
obstructive sleep apnoea[1,6,13].
In the most severe cases the child may fail to thrive.
Pulmonary complications arise from complex mecha-nisms
that increase pulmonary vessel resistance. When
this becomes persistent pulmonary hypertension and cor
pulmonale can occur. Serious complications leading to
death are rare[9].
Laboratory investigation
Polysomnogram (PSG) is considered the gold standard
for the diagnosis of sleep apnea and other sleep
disorders. It involves an overnight sleep in the laboratory
with multichannel monitoring of multiple physiologic
variables with the presence of a technician throughout
the study. During the study, sleep stages and sleep
continuity, respiratory effort, airflow, oxygen saturation,
body position, electrocardiogram, and movements are
recorded. In the analysis of the study, the number of
apneas per hour is expressed as AI, which determines the
severity of the OSA [1,7,8,9,11].
Management protocol for OSA
Dentists have recently become one of the team players in
the field of sleep medicine. Oral appliances for the
treatment of snoring and OSA fall into two main
categories – those that hold the tongue forward and those
that reposition the mandible (and the attached tongue)
forward during sleep[12,13].
Having concluded that treatment with an oral appliance
is indicated, the physician provides the dentist who has
the skill and the experience in oral appliance therapy
with a written referral or prescription and a copy of the
diagnostic report[14].[Table-2]
Oral appliances have been considered as treatment
option for upper airway obstruction caused by mandibul
ar deficiency since the early part of this century. In the
1980’s dentists and orthodontics teamed up with
pulmonologists to explore the use of oral appliances to
treat patients with OSA[15].
Conservative therapies include weight loss, changes in
sleep posture, placement of intraoral devices, nasal
continuous positive airway pressure (CPAP), and drug
therapy. Surgicalm methods include tracheostomy,
uvulopalatopharyngoplasty (UP PP), nasal septoplasty
and surgical mandibular advancement[14,15].
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Table
528-538 e-ISSN: 2349-0659,
2: Treatment Protocol for Oral Appliance Therapy
Treatment
Non specific therapy
Behavior modification include changing the sleep
position from the supine position to the side position;
this can be accomplished by placing a tennis ball in the
centre of the back of their dress or by positioning a
pillow such that they cannot roll on to their back
(positional training). The avoidance of alcohol
sedatives; they may also act as muscle relaxants,
reducing airway patency. In obese patients, weight
should be recommended. Even a 10% weight loss
reduce the number of apneic events for most
patients[16].
Specific therapy
Oxygen administration
Oxygen is sometimes used in patients with central
caused by heart failure. Oxygen at the correct flow
when used in conjunction with nasal continuous positive
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ning). and
ency. loss
can
apnea
rate
airway pressure (CPAP), however, in many cases
corrects this problem[18.19].
Continuous positive airway pressure appliance
(CPAP)
Continuous positive airway pressure is the gold standard
in treatment. CPAP treats
under pressure through a sealed face mask or a nose
mask through the upper airway to lung,
treatment is associated with poor patient
to lack of portability, pump noise, dryness of the
passage, and mask discomfort.
bedtime through a nasal or
velcro straps around the patient’s head. The mask is
connected by a tube to a small air compressor. The
CPAP machine sends air under pressure through the tube
into the mask, where it imparts positive pressure to the
upper airway. This essentially “splints” the upper airway
open and keeps it from collapsing in the deeper stages
Rapid eye movement sleep. The
the same way as a splint, holding the airway
open[20,21].
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38
532
ntinuous patient by pumping room air
however the
compliance due
ty, airway
CPAP is administered at
facial mask held in place by
of
pressure acts much in
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Pharmacological agent
Thyroid hormone supplementation might lead to
significant correction of the apnea if this is the sole
problem. Control of blood sugar levels has a moderate
effect in controlling the diagnosed obstructive sleep
apnea. Certain medications which increase respiratory
drive help some patients[20,22,23].
Surgical correction
Uvulopalatopharyngoplasty, partial tongue resection
tracheostomy, lingual plasty, genioglossal advancement
with hyoid myotomy and suspension nasal septal surgery
hyoid bone suspension, and mandibular advancement
osteotomy are the various surgical modalities suggested
for obstructive sleep apnea. In nasal, septal and adenoid
surgery weak or malpositioned cartilages around the
nostrils, droopy nasal tip or excessively narrow nostrils,
nasal septal deviation and enlarged adenoids are all
indicated for surgical interventions[24,25].
Tonsillectomy allows the removal of redundant tissue
and hence increases the caliber of the throat thereby
reducing blockage to breathing. Genioglossus tongue
advancement procedure produces a larger space between
the back of the tongue and the throat thereby creating a
wider airway. Uvulopalatopharyngoplasty (UPPP)
involves the removal of part of the soft palate, uvula and
redundant peripharyngeal tissues, sometimes including
the tonsils. Laser- assisted uvulopalatoplasty like UPPP
may decrease or eliminate snoring but not eliminate
sleep apnea itself.
Maxillomandibular advancement or double jaw
advancement is a procedure where the upper and lower
jaws are surgically moved forward. Radiofrequency
tissue volume reduction (RFTVR) is a surgical method
which uses radiofrequency heating to create targeted
coagulative submucosal lesions resulting in shrinkage of
the inner tissues leaving the outer tissues intact[26,27].
Hyoid suspension is a procedure which was developed
specifically for the treatment of OSA. The operation
advances the tongue base and epiglottis forward, thereby
opening the breathing passage at this level.
In Tracheostomy any area of blockage to breathing, from
the nose to the voice- box, is bypassed by a hole placed
into the windpipe[28, 29].
Oral appliance theraphy
Orthodontic appliances are made in such a manner that it
can be worn permanently or removeably depending upon
the condition.. Appliance are designed to bring the
mandible and tongue forward, opening up the lower
pharynx to allow unrestricted breathing [1,3,30,31].
[Fig.3]
Oral appliance are indicated for use in patients with
primary snoring or mild OSA who do not respond or are
not appropriate Candidates for treatment with behavioral
measures such as weigh loss or sleep position change;
Patients with moderate to servere OSA should have an
initial trial of nasal CPAP because greater effectiveness
has been shown with this intervention that with the use
of oral appliances; Oral appliances are indicated for
patients with moderate to severe OSA who are intolerant
of, or refuse treatment with, nasal CPAP, oral appliances
are also indicated for patients who refuse or who are not
candidates for tonsillectomy and adenoidectomy , cranial
facial operations or tracheostomy[32-34]. [Fig.4-5]
Figure 3: Obstructive Sleep Apnea osa appliances
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Figure 4: Here's an example of an appliance for snoring and sleep apnea: Dental Sleep Apnea Treatments
Figure 5: Mandibular Repositioning Appliance to treat sleep apnea and snoring
Dental devices include tongue retaining devices (TRD)
and mandibular advancement appliances (MAA).
Tongue retaining device is a splint that holds the tongue
in place to keep the airway as open as possible [Fig.6].
Mandibular advancement device (MAA) is by farther
most common type of dental appliance in use today. It
protrudes the mandible forward, thus preventing or
minimizing upper airway collapse during sleep.
Mechanism of action- oral appliances are worn only
during sleep and they help to maintain an open and
unobstructed airway by repositioning or stabilizing the
lower jaw, tongue, soft palate or uvula. Mandibular
advancement devices – as mentioned earlier the first use
of mandibular advancement devices was suggested by
Pierre Robin in 1903. it protrudes the mandible forward,
thus preventing or minimizing upper airway collapse
during sleep[Fig.7]. Currently available appliances: First
category: one piece appliance with no ability to advance
the mandible incrementally. Second category: Appliance
are principally tow piece in design and offer the potential
for incremental advancement. Third category: They
permit incremental advancement and lateral movement
of mandible. Tongue retaining devices: Tongue retaining
device is a splint that holds the tongue in place to keep
the airway as open as possible. They are excellent
devices for patients with Temperomandibular joint
sensitivity. There are several advantages of Tongue
retaining devices, they do not require retention from
dentition, minimal adjustments are required and cause
minimal sensitivity to teeth and temperomandibular joint
[1, 9, 30, 32][Fig.8].
Figure 6: Comfort and retention, the SUAD™ is an excellent appliance for those who grind their teeth
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Figure 7: Oral appliances may be used alone or in combination with other means of treating OSA, including
general health and weight management, surgery or nasal
Figure 8: ABU- Sleep Apnea System
Significant reduction in apneas for those with mild-to-moderate
apnea, they may also improve airflow for some
patient with severe apnea, improvement and reduction in
the frequency of snoring and loudness of snoring in most
patients and higher compliance rates than with CPAP[1-
9].
Mandibular advancement splints generate reciprocal
forces on the teeth and jaw that can result in acute
symptoms, as well as long-term dental and skeletal
changes. While mandibular advancement splints are
primarily attached to the dental arches, most extend
beyond these and thus apply pressure to the gums and
oral mucosa. The incidence of reported side effects and
complications vary significantly between studies. This is
probably due to difference in the type of oral appliance
used, the design of the oral appliance, the degree of
mandibular advancement, as well as the frequency and
duration of follow-up. During the acclimatization period,
it is common for adverse effects to develop, which are
usually minor and self-limiting. These include
execessive salivation, mouth dryness, tooth pain, gum
irritation, headaches, and temporomandibular joint
discomfort. Patients should have regular visits with a
health professional to check the devices and make
adjustments[27-29].
Future randomized controlled trials are needed to
compare the effectiveness of different types of
appliances and different design features (eg, the amount
of vertical opening). The effect of oral appliances on
excessive daytime sleepiness and performance must be
determined with objective and validated tools. The
precise indications, complication rates, and reasons for
treatment failure must be determined for each oral
appliance if it is going to be used in clinical practice[18].
Ongoing refinements of appliance design eventually may
lead to improved treatment outcomes. Only when the
mechanisms of action of oral appliance therapy are fully
understood can more effective appliances be developed.
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On the horizon for the field of oral appliance therapy is
the introduction of a compliance monitor that will allow
an objective determination of appliance usage. Several
investigators also are developing systems that would
allow overnight titration of oral appliances in the sleep
laboratory. This might ultimately shorten the time from
initiation of oral appliance therapy to optimization of the
appliance[21-25].
According to Brouillette and colleagues,[25] increasing
awareness of OSA and examination of sleeping patients
should result in earlier treatment and less morbidity for
infants and children with OSA. As adenotonsillar
hypertrophy is one of the main causes of OSA among
children, investigating the prevalence of OSA among
children with adenotonsillar hypertrophy is an important
research task. There is evidence that physicians may not
always recognize childhood OSA.
According to Konno and colleagues an average delay of
23 months occurred between identification of pediatric
patients with large tonsils and their referral to a sleep
clinic.[Table.3]
Among the physicians treating children, dentists are
most likely to identify adenotonsillar hypertrophy; thus,
it may be in the patient's best interests if dentists act as
“gatekeepers” in identifying children with adenotonsillar
hypertrophy. As discussed above, dentists are becoming
increasingly aware of sleep apnea in adults, as some are
involved in using OAs to treat this disorder. Once
dentists identify children with adenotonsillar
hypertrophy, they should inform the parents about the
risk of OSA and further inform their family physician
about the importance of sleep assessment in children
with enlarged tonsils. Involvement of dentists in this
process can contribute significantly to the health of
patients, as OSA, with such significant developmental
consequences, can be diagnosed and treated at an early
stage, preventing later problems and complications [19,
23, 25,35].
Table-3: Management of Obstructive Sleep Apnea
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Conclusion
The dentist has the benefit of an optimum view of the
throat of the patient and can therefore determine if it is
anatomically blocked and classify according to the
Mallampatic classification. The dentist can observe if the
patient displays any of the signs that produce snoring,
can determine via clinical history (20) or in and oral
anamnesis whether the patient snores and often the
dentist can ask the patients partner or spouse, which will
leave little doubt as to the presence of snoring. Often the
patient or his/her partner will inform the doctor without
prompting. How many times in social situations do we
hear complaints or comments related to snoring? There
exists a demand for the services of the dental surgeon
who can treat snoring and mild to moderate apneas. In
the general public, there is increasing awareness of the
field of sleep medicine and particularly as related to
obstructive respiratory problems. This growing
awareness is particularly true among medical surgeons.
Unfortunately, there are few dentists who are
appropriately trained to respond efficiently and ethically
to this need and it is therefore, important to increase their
numbers and distribution throughout the country. What
is also needed is that dentist play a greater role in the
field of sleep medicine.
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Source of Support: NIL
Conflict of Interest: None
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