Αρχειοθήκη ιστολογίου

Κυριακή 29 Μαΐου 2022

Call me maybe: Risk factors of impaired social contact during the COVID‐19 pandemic and associations with well‐being

alexandrossfakianakis shared this article with you from Inoreader

Abstract

The COVID-19 pandemic caused major societal changes worldwide, with the most notable being lockdowns and restrictions on social contact. We conducted a longitudinal study (total n = 1907) in Germany with two time points to (1) identify demographic risk factors of impaired social contact during the pandemic, as well as investigate potential consequences of (2) impaired social contact and (3) different modes of communication on individuals' well-being during the first lockdown in spring 2020. Results indicate that particularly individuals living alone and being unable to work reported a lower frequency of (face-to-face) contact in comparison with participants living with others or working. Impaired social contact was indirectly associated with a negative development in well-being (life satisfaction, anxiety and depression) over time, and this relation was mediated via relatedness. Moreover, the frequency of face-to-face and phone communication during lockdown was po sitively associated with relatedness and well-being; however, digital communication was not. The findings stress the importance of maintaining social contact in times of social distancing and of fostering reconnection between individuals once the pandemic is over.

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Long-term results of slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

alexandrossfakianakis shared this article with you from Inoreader

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Publication date: July 2022

Source: International Journal of Pediatric Otorhinolaryngology, Volume 158

Author(s): Eszter Erdélyi, Ádám Bach, Balázs Sztanó, Péter Gál, Kishore Sandu, Csaba Bereczki, László Rovó

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Carglumic acid in methylmalonic acidemia: Use of breast milk as an alternative vehicle to water

alexandrossfakianakis shared this article with you from Inoreader
Carglumic acid in methylmalonic acidemia: Use of breast milk as an alternative vehicle to water

We aim to report the use of breast milk (BM) as an alternative vehicle in a neonate with methylmalonic acidemia rejecting carglumic acid (NCG) diluted in water. The patient presented symptomatic acidemia and hyperammonemia and after refusal of oral NCG administration, the clinician consulted the Pharmacy Department for advice. Data sheet of NCG does not recommend administration in other vehicle than water. Consequently, a dissolution test was conducted in BM showing correct dissolution. The solution was well tolerated, and plasma ammonium concentrations remained within range in subsequent analytical controls.


Abstract

What Is Known and Objective

Carbaglu® or N-carbamylglutamate (NCG) is not recommended for administration in a vehicle other than water. We aim to report the use of breast milk (BM) as an alternative vehicle in a neonate rejecting NCG diluted in water.

Case Summary

A neonate diagnosed with methylmalonic acidemia presented symptomatology of acidemia and hyperammonemia. After the patient refused oral NCG administration, a dissolution test was conducted in BM showing correct dissolution. The NCG-BM solution was tolerated and plasma ammonium concentrations remained within range in subsequent analytical controls.

What Is New and Conclusion

BM as a vehicle for NCG is a safe and effective option for patients who refuse suspension in water and could lead to better treatment compliance in paediatric patients.

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Rapid, simple, and economical LC–MS/MS method for simultaneous determination of ceftazidime and avibactam in human plasma and its application in therapeutic drug monitoring

alexandrossfakianakis shared this article with you from Inoreader
Rapid, simple, and economical LC–MS/MS method for simultaneous determination of ceftazidime and avibactam in human plasma and its application in therapeutic drug monitoring

Pharmacokinetics/pharmacodynamics (PK/PD) targets of antibiotics are critical for optimizing their dosage regimens to maximize efficacy, minimize toxicity, and delay the emergence of resistance. Furthermore, a high heterogeneity is presented in patients that are known to exhibit variations in antimicrobial PK. Therefore, therapeutic drug monitoring of CAZ and AVI to evaluate the PK/PD targets and PK/PD-based dosage adjustment in patients are beneficial for rational use of these drugs. Herein, we developed and validated a simple method for the simultaneous determination of CAZ and AVI in human plasma using LC–MS/MS. Finally, the established and validated method was successfully applied to the determination of CAZ and AVI in plasma for patients. The results showed considerable PK variations in patients, demonstrating the great significance of TDM in the clinic.


Abstract

What is Known and Objective

Carbapenem-resistant Gram-negative bacterial pathogens continue to threaten public health. Avibactam (AVI), a novel non-β-lactam β-lactamase inhibitor, has been approved for use with ceftazidime (CAZ) mainly against carbapenem-resistant Enterobacteriaceae. Therapeutic drug monitoring (TDM) is urgently needed to optimize dosage regimens to maximize efficacy, minimize toxicity, and delay the emergence of resistance. This study aims to develop and validate a rapid, simple, and economical LC–MS/MS method for simultaneous determination of CAZ/AVI in human plasma.

Methods

Samples were processed by simple protein precipitation, and gradient elution strategy was applied to separate CAZ and AVI on a reverse-phase C18 column; with subsequent detection by the mass spectrometer in a positive and negative ion switching mode. Plasma samples from patients were analysed.

Results and Discussion

A 4-min run of LC–MS/MS was developed. The precision, trueness, matrix effect, extraction recovery, carry-over, dilution integrity, and stability were all acceptable for a bioanalytical method. The method was successfully applied to the determination of CAZ and AVI in patients, and a considerable PK variability of CAZ/AVI was observed among patients.

What is New and Conclusion

A robust, rapid, simple, and economical LC–MS/MS method for the simultaneous determination of CAZ and AVI was developed. The considerable PK variability of CAZ/AVI among patients demonstrates the clinical significance of TDM.

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Adapting narrative exposure therapy with a tribal community: A community‐based approach

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Objective

American Indian (AI) individuals are at increased risk for present-day trauma exposure and associated negative outcomes, as well as ongoing effects of intergenerational trauma exposure and adversity. However, few empirically supported treatments exist that are specifically tailored and/or tested with AI communities. This study describes the process of selecting, adapting, and implementing narrative exposure therapy (NET) with an AI community.

Methods

A community and academic partnership was formed and worked together to make culturally mindful changes to NET to best fit the needs of the community. The partnership incorporated community leaders/Elders (n = 7), providers (n = 11), and participants seeking treatment (n = 50) to implement an iterative process of adapting and implementing the adapted form of NET.

Results

Key adaptions included addressing historical and intergenerational trauma, greater protections for confidentiality in a small community, and incorporation of cultural customs and traditions. Overall, the adapted form of NET was favorably received by the participants, and the implementation appeared to be feasible, with improved retention over past trials of adapted trauma-focused treatments with this community and with highly positive satisfaction ratings and feedback.

Conclusions

NET was shown to be an appropriate approach for this AI community and should be considered as a treatment option for other AI communities. Future work should consider strategies outlined in this adaption as well as following a similar process for working with AI communities to implement culturally appropriate interventions for trauma-related symptoms.

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The concordance between wide-area transepithelial sampling with computer-assisted 3-dimensional analysis (WATS-3D) and standard endoscope biopsy in the detection of Barrett's esophagus and esophageal dysplasia

alexandrossfakianakis shared this article with you from Inoreader

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Publication date: Available online 28 May 2022

Source: Annals of Diagnostic Pathology

Author(s): Chaohui Lisa Zhao, Zarrin Hossein-Zadeh, Bahram Dabiri, Solomon Turunbedu, Gerasimos Karalis, Behnam Rafiee, Alex Pipas Rodriguez, Iman Hanna

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Subjective Sleep Complaints were Associated with Painful Temporomandibular Disorders in Adolescents: the Epidor‐Adolescere Study

alexandrossfakianakis shared this article with you from Inoreader

Abstract

Background

Sleep disturbances in adolescents has received a lot of attention in the literature and it is recognized as a serious health concern. The association between pain and sleep disturbances in adolescents has been extensively studied. However, to the best of our knowledge, there is a lack of studies investigating the association between various subjective sleep variables and painful TMD in adolescents.

Objectives

to investigate the association between painful TMD and subjective sleep variables in adolescents' non-clinical sample. We conducted a cross-sectional study. TMD was classified according to the RDC/TMD criteria. The Revised Face Scale evaluated TMD pain intensity, and pressure pain thresholds (PPTs) were assessed in trigeminal and extra-trigeminal areas. The subjective sleep variables were assessed according to the Sleep Disturbance Scale for Children and Sleep Behavior Questionnaire.

Results

The final sample consisted of 690 adolescents (12.7±0.76 years), with 16.2% of them presenting painful TMD. Adolescents who frequently reported waking up more than twice per night and feeling tired when awake were more likely to present painful TMD symptoms [OR= 1.7 (95% CI: 1.04-2.90); p=0.034 and OR= 1.6 (95% CI: 1.01-2.48); p=0.046, respectively]. The intensity of TMD pain was negatively associated with sleep quality (p=0.015). Also, PPT values in the trigeminal and extra-trigeminal areas were negatively associated with total sleep time (p= 0.048 and p=0.042, respectively).

Conclusions

the present results point out the importance of considering sleep complaints associated with painful TMD in adolescents.

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Is It Possible to Stop a Dental Abscess?

alexandrossfakianakis shared this article with you from Inoreader


In the spirit of full transparency, we didn't start OraWellness because we always had or were blessed with awesome oral health. We started OraWellness after we successfully created greater oral health and learned how to recover from rather unfortunate (and all-too-common) starting points.

If you've been with us for any time, you probably already know our 'origin story' and how Susan used at-home strategies to care for her oral health and successfully reverse advanced gum disease. (As an important side note, Susan accomplished this 'dental miracle' without any oral surgery or help from a dental hygienist.) 

And she continues to leave dentists scratching their heads in confusion, making comments like, "I can clearly see that you had gum disease. But I don't see any current signs of active infections.

The original dentist considered this a dental miracle, but after more than 12 years of sharing Susan's strategies with the world, we've realized that it's no miracle at all. However, it is amazing how quickly the body responds and heals itself when you accept the role of the MVP and take appropriate action.

Today's story will continue to explore this same theme of Susan's journey to greater oral health. We're going to share how Susan successfully healed an abscess after two dentists said it could only be addressed by removing the tooth.

Disclaimer: We are not qualified medical or dental professionals, so we can't treat, diagnose, make recommendations, etc. We're sharing this story for informational purposes only. Please don't mistake any of this content for suggestions of what you should do to treat an abscess. Abscesses are serious business that shouldn't be taken lightly. If you suspect you have one, here's a helpful resource you can use to find a qualified dentist to assist you.


What is a dental abscess?

An abscess is simply an infection, and it can occur anywhere in the body. In our oral health world, a 'dental abscess' refers to an infection under the gums, normally at the root of a tooth. A dental abscess commonly originates from three sources: a deep infection in the tooth or gum pocket, an injury, or old (failed) dental work. In particular, dental abscesses tend to show up around teeth that have been killed via a root canal.

In Susan's case, the abscess was at the root of a malformed tooth. It's always been a tooth that dentists have looked at and wondered what they were seeing. A well-known dentist told her it was two teeth growing as one. Other dentists had also told her that the tooth was 'dying'. Using a cone beam x-ray, a dentist found a periapical (meaning 'around the root') abscess. This type of abscess is pretty common.


How do you know if you have a dental abscess?

Abscesses are bacterial infections. As the infection progresses, it builds up pus that needs to go somewhere. If you've ever had a 'pimple' on your gum tissue (especially if it's recurring), this is a pretty sure sign of an infection in the tissue around the root of the tooth in that area. 

As pus continues to fill the abscessed area, it creates pressure, which can cause pain. Eventually, the increased pressure causes the abscess to vent, meaning it seeks a pathway for the pus to get out of the region. The problem is that sometimes, a dental abscess can vent into less-than-ideal places. For example, an infection in the upper jaw may vent into the sinus cavity. Luckily, Susan's dental abscess vented to the side of the gum next to her cheek. 

The problems and health risks associated with abscesses are real and may need to be diagnosed and addressed by a professional, but for the sake of this article, we want to explore how one person successfully stopped her own dental abscess.

If you question whether you have a dental abscess, this is a situation that needs attention. Please seek the support of a dental team that you trust, ideally one that will use 3D cone beam x-ray technology to make a diagnosis and help you determine a course of action.


The initial point of entry…

During our HealThy Mouth World Summit, we had the honor of interviewing Dr Hal Huggins (before he passed away a couple of years later). Thanks to that interview, we had the opportunity to send our x-rays to one of the experts who trained extensively with Dr Huggins.

This dentist explained that Susan's malformed tooth is a dental anomaly called 'dens in dente' (meaning 'tooth within a tooth') where the wisdom tooth and the molar in front of it came in 'together'. As it turns out, while this anomaly isn't common, it isn't super rare either.


Getting a cone beam 3D x-ray to confirm the problem

It's our understanding that the 3D x-ray technology called 'cone beam' is superior to traditional dental x-rays because it provides dental teams with a wider array of information and a much better understanding of what's going on under the surface.

So when we moved from Hawaii back to the mainland in 2018, Susan took advantage of the opportunity and got a cone beam scan. (While Hawaii is great for many things, holistic dentistry is not one of them.)

This was the first time a dentist diagnosed the abscess around this troublesome molar. His suggested course of treatment was to pull the tooth, let the area heal, and then place an implant.

And, just like when a previous dentist told Susan she had advanced gum disease, Susan said, "Hmm, ok, thanks for the information. I'm going to do some research on other options. I'll let you know if I want to schedule this." Then she promptly left the dental office and got to work. (Never forget that you're the boss, the MVP, of your oral health journey.)

As a side note, thermal imaging can also be a very helpful way to determine if an infection is brewing around a tooth. For someone who is looking to take action to make positive changes to their oral and/or whole-body health, thermography can help provide a sense of where infections might be lingering.


Confirmation of healing…

Before we jump into the strategies that might help address an abscess, we'd like to share the end of this story. Susan went to a new dentist close to home, who reviewed her cone beam x-ray from the previous dentist and proclaimed, "You have an abscess there. We've got to pull that tooth.

Susan explained that she had been supporting the region and wanted to get a more recent scan to see if any change had occurred. The dentist reluctantly agreed, and lo and behold, he found no more infection around that tooth! 🙂 

The dentist was excited, puzzled, and genuinely curious by this, and he enthusiastically asked Susan what she had done to address the infection (which, by the way, is a precious sign that the dentist is still open to learning and discovering new solutions). This led to a lively conversation about systemic immune support strategies, and the dentist confirmed that he understood how Susan's strategies had worked. 

Now that we've shared that backstory, let's shift to solutions and strategies that can help support the body's innate ability to get on top of an infection like a dental abscess.

Full disclosure: We're going to share a variety of helpful strategies and point out which general tracks Susan chose to take, but since the information in this article is not intended to be any kind of suggestion for what anyone else should do, we're not going to share any specific details about what she did. Trust your gut. Do what feels right to you. Read through the list of helpful strategies and see if any of them resonate with you. Applying even just one of the strategies can help increase the body's natural ability to get on top of an infection.


The challenge with accessing a dental abscess…

Here's the thing: an abscess that's located at or around a tooth root is not accessible from inside the mouth.

Yes, it might help somewhat if we put herbal poultices between the cheek and gum tissue right at the point of infection. But the bottom line is that unlike gum disease, with a dental abscess, you don't have access to address the source of the infection itself.

So, the primary route to address this issue is via whole-body, system-wide immune supporting strategies.

And, that means… Yep, we have to address things that we may not be thrilled to adjust at this point, like optimizing our diet.

Before we dive into dietary changes, let's start with some less intimidating strategies that can be applied at home or with the help of a caring dental team.


Simple at-home, in-the-mouth approaches:

Vigorous swishing with salt water – Salt naturally 'draws out' infections. So, while you don't have direct access to the infection, using salt may help to draw it to the surface. 

A commonly overlooked part of this strategy is the vigor with which to swish. It's important to really activate the area by vigorously swishing the salt water around the mouth. Feel free to download our free eBook, The Ultimate Oil Pulling Guidebook, which explains more about this type of 'vigorous swishing' strategy.

Make an herbal poultice – When it comes to solutions from nature, the sky's the limit. One idea is to try crushing up some garlic and tucking the crushed clove between the cheek and gum around the affected region. Crushing fresh oregano is another option. And there's always our favorite, crushed dandelion, to help clear heat and toxins.

Direct massage using HealThy Mouth Blend – Another pretty simple strategy is to gently massage 1-2 drops of our HealThy Mouth Blend into the affected area. The balanced formula will help soothe and support the region. We've received confirmation from several people in our community that this strategy really helped them manage a dental abscess.

A mixed approach – What about making up a poultice using some fresh crushed garlic, dandelion, and oregano with a pinch of salt, and then putting that 'bolus' between the cheek and gum near the affected region? While we don't generally believe that 'more is better', in this case, there may be some benefit to mixing various supportive herbs.


Dentist-supported in-the-mouth strategy:

Application of ozone gas into the infection – Here's a novel idea that some dentists have been willing to contemplate. If you have a dentist who works with ozone gas (a minority for sure), feel free to ask them if they would be willing to inject a syringe of ozone gas into the periapical region. Slow release of ozone into the site of the infection could go a LONG way toward helping to reduce the localized infection. This simple strategy solves the issue of not being able to access the dental abscess by placing an amazingly powerful anti-infective, ozone, directly where it's needed.

They might need to do more than one injection, but given that we're trying to avoid having a tooth extracted, it's worth the effort.

Alternatively, a strategy that Susan used was to massage a drop of ozonated oil onto the affected site. Although this might not directly reach the epicenter of the infection, the advantage of this supportive strategy is that it doesn't require assistance from a dental team. Here's a link to some quality ozonated oils.


System-wide immune support strategies:

Homeopathics – Let's start with the easiest support. It's our understanding (and was Susan's experience) that the homeopathic remedy Hepar Sulphuris Calcareum (aka 'Hepar Sulph') is fantastic for helping to drain infections like an abscess. Here's a great resource to learn more about using homeopathy for dental abscesses.

High-dose vitamin C – It's been known for many decades now: vitamin C is a powerful anti-infective agent that can even help to address super serious issues like sepsis (1). So, while you want to be cautious if you're going to use high doses, stepping up your vitamin C intake can help to support oral healing (2) and 'cook out' any lingering infections.

Keep in mind, if you take too much, your body will let you know with pretty profound diarrhea. The strategy here is to find your 'near bowel tolerance' amount, which is just under the amount that causes diarrhea. Holding at near bowel tolerance for a few weeks can certainly help address chronic infections.

Optimize vitamin D intake – Another easy strategy is to make sure that you're getting plenty of vitamin D. And if you're going to increase your D, please be sure to increase your vitamin K2 as well. At the advice of a doctor, Susan supplemented with therapeutic doses of vitamin D for a period of time. 

While there's plenty of both good and bad PR about vitamin D, there are many accounts of people taking pretty high amounts of vitamin D for shorter periods of time to help ramp up immune function so they can knock out an infection.


Supportive strategies at a professional clinic:

Intravenous vitamin C (and other goodies) – High doses of oral vitamin C can trigger the 'bowel tolerance' that we discussed. However, we can receive much higher amounts of vitamin C intravenously without the rush to the bathroom.

Plus, if you work with a naturopathic doctor, they might have other beneficial compounds that they could work into an immune-supporting 'cocktail' to deliver intravenously along with the vitamin C.

Note: folks who have a genetic disorder known as 'G6PD deficiency' could experience serious complications from high dose intravenous vitamin C. So if you're not sure if you have this genetic predisposition, be sure that your doctor tests for it before you try intravenous vitamin C.

Hyperbaric oxygen therapy – Hyperbaric oxygen therapy (HBOT) continues to show tremendous immune system benefits. It helps deliver oxygen into tissues, and it's especially helpful for low-oxygen areas that need the extra boost.

While 'on-label' HBOT treatment is limited to conditions like gangrene, severe burns, slow healing wounds like diabetic ulcers, and crush injuries, the data is super clear that breathing oxygen while under hyperbaric pressure provides profound benefits, especially for addressing lingering chronic infections (3).

This makes sense because many of the bacteria that are associated with chronic infections tend to thrive in an anaerobic (oxygen-deprived) environment, so when we supersaturate the surrounding tissues with oxygen, it's more difficult for these anaerobic bacteria to survive.

You can find more information on the use of hyperbaric oxygen here. One word of caution: to ensure that you get the maximum benefit from HBOT, there are two crucial factors to consider: 

  1. While in the tank, you must be delivered pure (100%) or close-to-pure oxygen via a mask.
  2. Pressures must be equal to or greater than 1.6 atmosphere absolute (ATA).

There are lots of HBOT spas around the world now. Unfortunately, many of them take advantage of an unknowing public to get new people into their clinics. Most of the HBOT centers we've seen do not have the capacity to deliver pure oxygen at the pressures that are necessary in order to provide this therapy's benefits.

If you're looking to leverage HBOT to support the healing of a dental abscess, it would be ideal if you could get a handful of sessions where they take you down to 2.0 ATA while breathing pure oxygen.


Other systemic support strategies:

Now let's broaden this out to strategies that we all know are good for us. Improving our diet, getting optimal exercise and outdoor time, spending quality time with loved ones, and making time for contemplation/prayer/meditation are all awesome for our immune health. But, many of us find it difficult to start implementing these kinds of lifestyle changes.

The strategy here is to just pick one today.

What's the easiest, lowest hanging fruit for you?

Can you stop the sodas? Reduce your coffee consumption? Provide yourself with a little more rest or self-care time on the weekend?

Really, anything we do to help us feel a little more cared for can go a long way toward supporting a general feeling of ease and well-being. And that, friends, is what moves the needle of our immune function.

Here are a few resources to help you along this path:


Wrapping up…

In conclusion, is it possible to stop a dental abscess without a tooth extraction? Based on Susan's experience, we believe it is. In fact, we know it is. 

Remember, the most important step of this entire process is to put on your superhero cape and become the MVP of your health journey (and finding a good dental team who will work with you to help monitor your progress can be a big help, too).

We're here with you every step of the way. If you have any questions, please holler. We can't give medical or dental advice, but we can listen, help you brainstorm ideas, and share resources to help you navigate your path to optimal oral (and whole-being) health.

What about you–what immune-supportive strategies have helped in your life? What hurdles have you overcome by taking the lead on your health journey? Please share your stories in the comments below. Together we can learn so much from one another!


Helpful, related resources:


Other resources:

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