Objectives
To assess early versus late treatment of Class III syndrome for skeletal and dental differences.
Methods
Thirty-eight Class III patients treated with a chincup were retrospectively ...analyzed. Baseline data were obtained by reviewing pretreatment (T0) anamnestic records, cephalograms, and casts. The cases were assigned to an early or a late treatment group based on age at T0 (up to 9 years or older than 9 years but before the pubertal growth spurt). Both groups were further compared based on posttreatment data (T1) and long-term follow-up data collected approximately 25 years after treatment (T2).
Results
Early treatment was successful in 74% and late treatment in 67% of cases. More failures were noted among male patients. The late treatment group was characterized post therapeutically by significantly more pronounced skeletal parameters of jaw size relative to normal Class I values; in addition, a greater skeletal discrepancy between maxilla and mandible, higher values for mandibular length, Cond-Pog, ramus height, overjet, anterior posterior dysplasia indicator (APDI), lower anterior face height, and gonial angle were measured at T1. The angle between the AB line and mandibular plane was found to be larger at T0, T1, and T2, as well as more pronounced camouflage positions of the lower anterior teeth at T0. The early treatment group was found to exhibit greater amounts of negative overjet at T0 but more effective correction at T1.
Conclusions
Early treatment of Class III syndrome resulted in greater skeletal changes with less dental compensation.
Introduction: Smoldering multiple myeloma (SMM) is a heterogeneous clinical entity that defines patients in the spectrum of disease progression from monoclonal gammopathy of undetermined significance ...to multiple myeloma (MM). Current standard of care is observation until end organ damage occurs. In spite of this, the scientific community has begun to question whether the strategy of watchful waiting should be replaced with earlier therapeutic intervention with the ultimate goal of preventing clonal heterogeneity and end organ damage.Areas covered: In this review, we challenge the concept of observation as the best option of therapy in SMM. We present current data on diagnosis, prognostic factors of disease progression and studies that have been conducted to date to determine whether earlier therapeutic interventions will lead to an improvement in overall survival of patients with MM.Expert opinion: If the recommendations of treatment of SMM were to change, the scientific body of evidence would have to overcome four major hurdles: to demonstrate that early intervention leads to prolonged survival and delay in development of end organ damage, that it does not have long-term toxicities, that it is implemented in patients with a high-likelihood of developing myeloma and that it does not lead to the outgrowth of more resistant clones. Only well-designed clinical trials will determine whether cure can be achieved with earlier interventions.
Abstract Background Paroxysmal (PS) and unusual symptoms (US) as initial manifestation of multiple sclerosis (MS) are rare and often thought to indicate “benign” MS. Objective To investigate ...prevalence and clinical disease course of patients experiencing PS or US as first clinical manifestation. Methods Clinical, MRI and cerebrospinal fluid data of patients presenting with PS and US were obtained retrospectively and compared to patients with classical bout onset (CS). Results In a cohort of 1,396 relapsing onset patients, 15 (1.1%) were identified as presenting with PS and 7 (0.5%) with US. Groups were comparable regarding gender, age at onset and intrathecal immunoglobulin synthesis (p>0.05). During a mean follow-up period of 13.6 years, all patients presenting with PS or US converted to CDMS (mean duration 3.4 years; 95% CI 1.9 – 4.8) as compared to 1,374 patients (94%) presenting with CS (mean duration 3.2 years; 95% CI 3.0 – 3.4; p=0.759). Conclusion In a cohort of 1,396 MS patients, 1.6% presented with PS or US at disease onset. Irrespective of the initial transient symptoms, patients were at the same risk of developing CDMS as CS patients, thereby underlining the importance of identifying PS and US as possible first clinical symptoms of MS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Clinical and biochemical improvements are reported on Mucopolysaccharidosis type VI (MPS VI) patients on Enzyme Replacement Therapy (ERT) with rhASB (galsulfase, Naglazyme®), and preclinical and ...clinical studies have shown clinical benefits of early initiation. We report four unrelated MPS VI children who began ERT as infants (ages 5days–10months). The three older patients showed the first clinical signs of MPS VI at baseline, also presenting different degrees of dysostosis multiplex, and two had mild heart disease. The two oldest also had mild facial coarseness, one had hearing conduction deficit and sleep disorder and the other corneal clouding at baseline. After six years on ERT, all four patients have normal urinary GAG values. Although they all showed normal motor and mental development, brain and cervical spine MRI images available from two of the older patients showed abnormalities, while the youngest child continues having normal images. The four patients presented slower progression of bone and joint disease when compared to their affected older siblings. It should be noticed that only two patients in this sample are currently below the 3rd percentile for height: the youngest who has a constitutional factor associated and the eldest who already presented frank dysostosis at 10months of age. These findings confirm previous studies that report that skeletal features of the disease cannot be completely prevented despite early ERT. Heart disease already present in two of the four infants at baseline got worse over time and appeared in another patient, but the youngest child on ERT introduction still has a normal echocardiogram at six years of age; he also is the only one without corneal clouding after six years follow-up. Our results also suggest that early ERT prevented storage in spleen and liver and may also have improved or prevented progression of facial dysmorphic features, corroborating similar findings seen in previous studies. No safety concerns were identified and none of the patients experienced a serious adverse event. The baseline severity of the disorder of these four infants seems related to age and it is tempting to say that severity on the first year of life is progressive and ERT effectiveness is indirectly related to it. Despite being known that MPS VI progresses differently among patients, the fact that these infants had a slower progression than their older siblings speaks in favor of a very early start of ERT. In conclusion, this report confirms the early manifestations of the disease and provides additional evidence on safety and of the beneficial effects of ERT in patients less than 1year of age.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The purpose of this review was to summarize research on the clinical benefits of early treatment for Alzheimer's disease via a focused discussion of data on donepezil. Well‐controlled clinical trials ...demonstrate that donepezil is effective in stabilizing or slowing progressive decline in cognition, function, and behavior. Several studies reveal statistically significant and clinically meaningful advantages to initiating treatment early in the course of the disease. Benefits of donepezil treatment include behavioral stabilization and preserved independence, in addition to slowed cognitive decline. Epidemiologic studies and evidence from histopathology underlie a rationale for treating patients who are cognitively impaired but do not have dementia. Clinical trials in such patients indicate that treating patients with mild cognitive impairment (MCI) may delay the onset of Alzheimer's dementia. Substantial evidence favors initiating treatment early in the course of dementia and reinforces the necessity to assess behavior and activities of daily living to accurately evaluate treatment response. Results of early studies of donepezil in MCI are promising and suggest directions for further research.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Peru is characterized by high cervical cancer incidence and mortality rates. The country also experiences significant gaps in quality cervical cancer screening coverage for the population.
This ...descriptive mixed methods study conducted in Cusco, Peru, aimed to assess the attitudes and perceptions of medical staff, health care workers, and patients toward a cervical cancer screening program that included both clinic-based and community outreach services conducted by a nongovernmental organization clinic (CerviCusco). The study also explored patient knowledge and attitudes around cervical cancer and about the human papillomavirus (HPV) to inform patient education efforts.
The study employed structured interviews with key informants (n=16) primarily from CerviCusco, which provides cervical cancer prevention, screening, diagnosis and treatment services, and surveys with a sample of patients (n=30) receiving services at the clinic and at screening campaigns.
The majority of key informant medical staff participants felt that the general public had a very negative view of government health services. One theme running throughout the interviews was the perception that the general population lacked a culture of preventive health care and would wait until symptoms were severe before seeking treatment. Regarding services that were received by patients at CerviCusco, the participants responded that the prices were reasonable and more affordable than some private clinics. Patients attending the rural health campaigns liked that the services were free and of good quality.
CerviCusco has demonstrated its capacity to provide screening outreach campaigns to populations who had not previously had access to liquid-based cytology services. The finding that patients had generally low levels of knowledge about cervical cancer and the HPV vaccine prompted the development of culturally and linguistically appropriate educational and promotional materials to improve the educational component of the periodic campaigns conducted primarily in rural areas of Andean Peru.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The adoption of Internet of Things devices and, more in general, embedded systems, endowed with sensors and actuators, keeps rising globally, and the scope of their involvement broadens, for instance ...in e-Health applications. This work describes our integration of IoT paradigms and resource ecosystems with a tailored Cloud-oriented device-centric environment, by focusing on an e-Health scenario, featuring monitoring and early treatment of hospitalized patients, by focusing on Cloud-enabled event detection coupled with coordinated reaction.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This study was conducted to determine COPD severity at the time of diagnosis as confirmed by spirometry in patients treated in a US managed care setting.
All patients with one or more inpatient ...stays, one or more emergency department visits, or two or more outpatient visits with diagnosis codes for COPD during 1994-2006 were identified from the Lovelace Patient Database. From this group, a subset of continuously enrolled patients with evidence in claims of a first available pulmonary function test or pulmonary clinic visit and a confirmatory claim for a COPD diagnosis was selected. Medical chart abstraction was undertaken for this subset to gather information for diagnosis and severity staging of each patient based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD.
Of the 12,491 patients with a primary or secondary COPD diagnosis between 1994 and 2006, there were 1520 continuously enrolled patients who comprised the study cohort. Among the 648 eligible records from patients with evidence of a pulmonary function test, 366 were identified by spirometry as having COPD of GOLD stage I or higher (average percentage of predicted forced expiratory volume in 1 second: 60%): 19% were diagnosed at the stage of mild disease (GOLD stage I); 50% at moderate disease (GOLD stage II); and 31% at severe or very severe disease (GOLD stage III or IV, respectively). The majority of patients in these groups were not receiving maintenance treatment.
The results demonstrate a very low incidence of early-stage diagnosis, confirmed by a pulmonary function test, of COPD in a large US sample and support calls for increased screening for COPD and treatment upon diagnosis.
The aim of this study was to assess the orthodontic treatment effects on unilateral posterior crossbite in the primary and early mixed dentition by systematically reviewing the literature. A ...literature search was performed by applying the Medline database (Entrez PubMed) and covering the period from January 1966 to October 2002. The inclusion criteria were primary and early mixed dentition with unilateral posterior crossbite, randomized controlled trials (RCT), prospective and retrospective studies with concurrent untreated as well as normal controls, and clinical trials comparing at least two treatment strategies without any untreated or normal group involved. Two reviewers extracted the data independently and also assessed the quality of the studies. The search strategy resulted in 1001 articles, and 12 met the inclusion criteria. Two RCTs of early treatment of crossbite have been performed, and these two studies support grinding as treatment in the primary dentition. There is no scientific evidence available to show which of the treatment modalities, grinding, Quad-helix, expansion plates, or rapid maxillary expansion, is the most effective. Most of the studies have serious problems of lack of power because of small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or lack of statistical methods. To obtain reliable scientific evidence, better-controlled RCTs with sufficient sample sizes are needed to determine which treatment is the most effective for early correction of unilateral posterior crossbite. Future studies should also include assessments of long-term stability as well as analysis of costs and side effects of the interventions.
In the 18th and 19th centuries, dentists ‘‘straightened’’ the teeth of adolescents and adults. Angle had suggested that earlier treatment would be advisable but presented very few examples of this ...approach. In 1912, E. A. Bogue was the first orthodontist to publish articles advocating treatment for children before they reached the age of six by widening arches to create diastemas between temporary teeth and, above all, by eliminating mouth breathing.
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