Lana El Osta

Comparison of the OHIP-14 and GOHAI as measures of oral health among elderly in Lebanon

BackgroundThe respective abilities of the GOHAI and OHIP-14 to discriminate between aged patients with different levels of oral diseases have rarely been studied in developing countries. The aim of this study was to compare the discriminative abilities of the OHIP-14 and the GOHAI in an elderly Lebanese population, and particularly to identify persons with different masticatory function.MethodsA sample of elderly, aged 65 years or more, living independently was recruited in two primary care offices in Beirut, Lebanon. Data were collected by means of personal interview and clinical examination. The Arabic OHIP-14 and GOHAI questionnaires were used after cultural adaptation for use in Lebanon. The internal consistency, reproducibility and concurrent validity were verified. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile respectively and logistic regressions were conducted using socio-demographic, clinical and subjective explanatory variables.ResultsTwo hundred and six participants were included; mean age was 72 years and 60% were women. Good psychometric properties were observed for both questionnaires for internal consistency (Cronbach’s alpha>0.88), reproducibility (ICC>0.86) and concurrent validity. Strong correlations were found between GOHAI and OHIP-14 scores but a high prevalence of subjects with no impact was observed using the OHIP-14. Both questionnaires were able to discriminate between participants according to age, perception of temporomandibular joint (TMJ) pain or functional status as represented by the number of dental Functional Units (FU). GOHAI was more discriminant since it identified participants with high dental care needs: high numbers of decayed teeth, low numbers of teeth and socially deprived status.ConclusionsLebanese elderly with high dental care needs and impaired oral health were identified more easily with the GOHAI. These results may guide the choice of dental indicators to use in a national geriatric survey.

The pertinence of oral health indicators in nutritional studies in the elderly

BACKGROUND AND AIM Studies concerning the more appropriate criteria for evaluating oral health in relation to nutrition in the elderly vary greatly. There is a need to identify the most relevant criteria for classifying dental indicators of mastication in nutritional studies, so these indicators may be considered for epidemiological and clinical purposes. The aim of this study was to explore the associations between nutritional deficit and measures of oral health in a group of elderly. METHODS A convenience sample of independent elderly aged 65 years or more attending two primary care clinics in Beirut, Lebanon was selected. Data were collected from a questionnaire including the Mini-Nutritional Assessment (MNA), Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia and chewing problems. The oral examinations recorded decayed, missing and filled teeth (DMFT), the prosthetic status and the number of functional units (FU). RESULTS The sample was composed of 121 women (mean age: 71.59 ± 5.97 years) and 80 men (mean age: 72.74 ± 6.98 years). They were allocated to two groups: 85 participants suffering from malnutrition (MNA score < 17, n = 17) or at risk of malnutrition (17 < MNA score < 24, n = 68) and 116 participants with a normal nutritional status (MNA score ≥ 24). Parameters that explain MNA variations were perception of xerostomia (OR = 3.49, 95% CI [1.66-7.34]), number of FU (OR = 2.79, 95% CI [1.49; 5.22]), and GOHAI score (OR = 2.905, 95% CI [1.40; 6.00]). CONCLUSION Further studies exploring factors affecting nutrition in the elderly should take into consideration perception of xerostomia, number of FUs and GOHAI score.

Road map for pain management in pancreatic cancer: A review

Beside its poor prognosis and its late diagnosis, pancreatic cancer remains one of the most painful malignancies. Optimal management of pain in this cancer represents a real challenge for the oncologist whose objective is to ensure a better quality of life to his patients. We aimed in this paper to review all the treatment modalities incriminated in the management of pain in pancreatic cancer going from painkillers, chemotherapy, radiation therapy and interventional techniques to agents under investigation and alternative medicine. Although specific guidelines and recommendations for pain management in pancreatic cancer are still absent, we present all the possible pain treatments, with a progression from medical multimodal treatment to radiotherapy and chemotherapy then interventional techniques in case of resistance. In addition, alternative methods such as acupuncture and hypnosis can be added at any stage and seems to contribute to pain relief.

Acute blepharitis: an unusual complication of zoledronic acid

Dear Editor, Millions of patients are now taking medications for the treatment of osteoporosis, which represents actually a major health care issue. The most frequently prescribed drugs are the bisphosphonates, powerful inhibitors of osteoclastic activity. Randomized controlled trials have documented their efficacy in the prevention of bone loss and in the reduction of fractures in postmenopausal women and men with established osteoporosis. However, multiple rare safety issues that were not observed in clinical trials have now emerged with post-marketing surveillance and increasing clinical experience, such as inflammatory eye reactions. We will report a case of a 62-year-old osteoporotic woman who presented for management of a recurrent swollen left eye that followed the introduction of the zoledronic acid. We will also present a mini-review of the available data on bisphosphonate-reported ocular side effects.

Successful treatment of Evans syndrome with Tacrolimus

The patient presented to our center in October 2008 with severe thrombocytopenia along with hemolytic anemia and was then diagnosed with Evans Syndrome. All necessary blood tests to rule out co-existing infection or systemic disease were thoroughly investigated. During her hospitalization, she had an acute hemorrhagic stroke and was transferred to the intensive care unit where plasma exchange was performed; several sessions of plasma exchange followed and hemolysis ceased as a result. However, thrombocytopenia persisted. Subsequently, the patient was started on oral Cyclosporine (Cyclosporine Therapeutic index: 300–400 nanograms/mL) with a combination of Cyclophosphamide, Vincristine and anti-D immune globulin. Unfortunately, this combined therapy failed to increase and maintain an adequate platelet count and the patient was referred for matched sibling hematopoietic cell transplantation in June 2010. After an initial increase in platelet counts, without ever reaching a threshold of 100 000/mm, the platelet levels began to fluctuate in August 2010 and started dropping again in October of the same year to a nadir of 5 000/mm. Since then, the patient was re-challenged with multiple lines of therapy such as follows: Glucorticoids, Rituximab, Mycophenolate Mofetil, Eltrombopag and finally Cyclosporine. However, none of these agents showed a significant or durable response, making the patient mostly transfusiondependent since then. In January 2014, the patient was no longer prescribed Cyclosporine and prednisone. Instead, she was given Tacrolimus at an initial dose of 3 mg every twenty-four hours in two divided doses. The aim was to target whole‐blood trough levels of 10–20ng/ml. Within 4 weeks, her platelets had reached 30 000/mm after Tacrolimus dosing was increased to 5 mg per day (5000/mm when Tacrolimus was started). In March, her platelet levels reached 60,000/mm and kept Invest New Drugs (2015) 33:254–256 DOI 10.1007/s10637-014-0155-9

Oral health and chemotherapy act as cofactors in malnutrition in the elderly with other cancers than head and neck malignancies

ObjectivesThis study explores whether the chemotherapy regimen has a role in inducing oral health problems and malnutrition in elderly patients with other cancers than head and neck malignancies.Material and methodsAn observational cross-sectional study was designed to compare the relationships between oral health and nutritional status between four groups of elderly differing in cancer or chemotherapy regimen. Data were collected using a questionnaire including the Mini-Nutritional Assessment (MNA), the Geriatric Oral Health Assessment Index (GOHAI) and questions about perception of xerostomia. The oral examinations recorded the number of functional dental units (PFU) and the presence of oral lesions.ResultsThe sample comprised 46 patients receiving chemotherapy, 48 patients on a non-chemotherapy regimen, 45 persons in complete remission not under treatment and 53 non-cancer patients. Oral health perception was significantly worse in chemotherapy patients. They reported limiting the kinds of food they consumed, the discomfort felt when eating and took medications for oral pain. Oral lesions were frequent in chemotherapy participants. Nutritional status was related to the cancer treatment regimen (OR = 4.17; p value = 0.017), the presence of oral lesions (OR = 4.51; p value = 0.003), perception of xerostomia (OR = 3.54; p value = 0.012), the number of PFU (OR = 2.51; p value = 0.046) and GOHAI score (OR = 1.617; p value = 0.019).ConclusionThe presence of oral lesions and the chemotherapeutic regimen were highly associated with nutritional status in older patients with cancer.Clinical relevanceDental professionals should be asked to intervene preventively and per-therapy to optimise oral health status in elderly patients with other cancers than head and neck malignancies.

Benefits and Potential Risks of Bisphosphonate Therapy : A Narrative Review

Bisphosphonates have been proven to be effective and safe to millions of osteoporotic and cancer patients but were associated with multiple complications. The most prevalent and well established are upper gastrointestinal discomfort for oral bisphosphonates and acute phase reactions for intravenous forms. Although rare, hypocalcaemia and renal injury could be potentially serious. Severe musculoskeletal pain and ocular events may be ignored by physicians, which delay their diagnosis and management. Recently there are growing concerns over two long-term and emerging adverse effects, which are still of unclear pathophysiology and unproven causality. Osteonecrosis of the jaw is more common in cancer sufferers who receive high doses of intravenous bisphosphonates. Atypical femoral fractures are very rare compared with osteoporotic fractures that bisphosphonates prevent. Based on current data, the association of bisphosphonates with esophageal cancer, hepatotoxicity and atrial fibrillation remains doubtful. Overall, the adverse effect profile of these drugs is still unclear. Physicians must be vigilant to bisphosphonate-reported side effects and recognize the level of evidence supporting them, to better communicate the balance between benefits and potential risks to patients.