Dietary supplement interactions with medications used commonly in dentistry

Predictors of Third-Party Tested Nutritional Supplementation Use Among DI and DIII Student-Athletes at A Northeast University

Nutritional supplements (NS) are linked to adverse events and unintentional doping among college-athletes. The use of third-party tested (TPT) NS can increase safety and reduce the risk of inadvertent consumption of banned substances. The purpose of this study was to examine self-reported use of TPT supplements between the National Collegiate Athletic Association (NCAA) Division I (DI) and Division III (DIII) college-athletes and explore the potential predictors of TPT use. This cross-sectional study used data from a web-based, 50-question survey on supplement use, behaviors, and knowledge. A total of 271 individuals completed the survey, 118 athletes (66.9% DI, 33.1% DIII) were included in the analysis due to completion of TPT NS questions. Among this sample, 80.5% of student-athletes reported use of TPT NS, however, only 17.8% of students reported consistent use of TPT NS. In the multivariable model adjusted for athletic division, sex, and sport-type, student-athletes who preferred information from a strength and conditioning coach or athletic trainer were 69% less likely to report consistent use of TPT NS across all categories when compared to those who preferred going to a registered dietitian nutritionist (RDN). Student-athletes with limited access to an RD/RDN were more likely to use an athletic trainer or strength and conditioning coach for supplement information. Having dedicated RDNs within athletic departments may benefit athletes when it comes to safe NS use. Programs should also consider additional supplement education to athletic trainers and strength and conditioning coaches to help ensure safe and effective use of NS.

Patient safety in dental care: an integrative review

Adverse events pose a serious problem for quality of healthcare. Dental practice is eminently invasive and involves close and routine contact with secretions; as such, it is potentially prone to the occurrence of adverse events. Various patient safety studies have been developed in the last two decades, but mostly in the hospital setting due to the organizational complexity, severity of the cases, and diversity and specificity of the procedures. The objective was to identify and explore studies on patient safety in Dentistry. An integrative literature review was performed in MEDLINE via PubMed, Scopus via Portal Capes, and the Regional Portal of the Virtual Health Library, using the terms patient safety and dentistry in English, Spanish, and Portuguese, starting in 2000. The research cycle in patient safety was used, as proposed by the World Health Organization to classify studies. We analyzed 91 articles. The most common adverse events were allergies, infections, diagnostic delay or failure, and technical error. Measures to mitigate the problem highlight the need to improve communications, encourage reporting, and search for tools to assist the management of care. The authors found a lack of studies on implementation and assessment of the impact of proposals for improvement. Dentistry has made progress in patient safety but still needs to transpose the results into practice, where efforts are crucial to prevent adverse events.

Potential drug interactions with dietary and herbal supplements during hospitalization

Dietary and herbal supplements (DHS) are widely used in the general population, including during hospitalization. Yet, their potential interactions with prescription drugs have seldom been delineated among inpatients. We aimed to evaluate potentially dangerous interactions of DHS with prescribed medications among inpatients. This was a cross-sectional prospective study involving a cohort of patients hospitalized in 12 departments of a public academic medical center (Bnai Zion Medical Center, Haifa, Israel) from 2009 to 2014. DHS users were determined via a questionnaire. The Natural Medicine database was used to search for potential DHS-drug interactions for identified DHS, and the clinical significance was evaluated using Lexi-interact online interaction analysis. Medical files were assessed for documentation of DHS use. Univariate and multivariate logistic regression analyses were used to characterize potential risk factors for DHS-drug interactions. Of 927 patients consenting to answer the questionnaire, 458 (49 %) reported DHS use. Of these, 215 (47 %) had at least one potential interaction during hospitalization (759 interactions). Of these interactions, 116 (15 %) were potentially clinically significant. Older age [OR = 1.02 (1.01-1.04), p = 0.002], males [OR = 2.11 (1.35-3.29), p = 0.001] and increased number of used DHS [OR = 4.28 (2.28-8.03), p < 0.001] or drugs [OR = 1.95 (1.17-3.26), p = 0.011] were associated with potential interactions in DHS users. Physicians documented only 16.5 % of DHS involved in these interactions in patients' medical files. In conclusion, a substantial number of inpatients use DHS with potential interactions with concomitant medications. Medical staff should be aware of this, question patients on DHS usage and check for such interactions.

Adverse events associated with interactions with dietary and herbal supplements among inpatients

AIMS

Dietary and herbal supplements (DHS) are commonly used among inpatients and may cause interactions with drugs or other DHS. This study explored whether adverse events were actually associated with such interactions and examined specific characteristics among inpatient DHS users prone to such adverse events.

METHODS

This was a cross-sectional study of 947 patients hospitalized in 12 departments of a tertiary academic medical centre in Haifa, Israel. It evaluated the rate of DHS use among inpatients, the potential for interactions, and actual adverse events during hospitalization associated with DHS use. It also assessed whether DHS consumption was documented in patients' medical files. Statistical analysis was used to delineate DHS users at risk for adverse events associated with interactions with conventional drugs or other DHS.

RESULTS

In 17 (3.7%) of the 458 DHS users, an adverse event may have been caused by DHS-drug-DHS interactions. According to the Drug Interaction Probability Scale, 14 interactions 'probably' caused the adverse events, and 11 'possibly' caused them. Interactions occurred more frequently in older patients (P = 0.025, 95% CI: 2.26-19.7), patients born outside Israel (P = 0.025, 95% CI: 0.03-0.42), those with ophthalmologic (P = 0.032, 95% CI: 0.02-0.37) or gastrointestinal (P = 0.008, 95% CI: 0.05-0.46) comorbidities, and those using higher numbers of DHS (P < 0.0001, 95% CI: 0.52-2.48) or drugs (P = 0.027, 95% CI: 0.23-3.77).

CONCLUSIONS

Approximately one in 55 hospitalizations in this study may have been caused by adverse events associated with DHS-drug-DHS interactions. To minimize the actual occurrence of adverse events, medical staff education regarding DHS should be improved.

Interactions between dietary supplements in hospitalized patients

Inpatient consumption of dietary and herbal supplements (DHS) has recently received research attention, particularly due to potential DHS-drug interactions. Nevertheless, DHS-DHS interactions have seldom been evaluated among hospitalized patients. We evaluated potential DHS-DHS interactions among inpatients. The study was a cross-sectional prospective study, conducted at Bnai Zion Medical Center (Haifa, Israel) in 2009-2014. A multi-disciplinary team of researchers constructed a questionnaire aimed at detecting DHS use among inpatients. The Natural Medicine Database was used to examine identified DHS for potential DHS-DHS interactions. Then, medical files were reviewed to identify side effects potentially caused by such interactions and rate of documentation of DHS use. Univariate and multivariate logistic regression analyses were conducted to characterize potential risk factors for DHS-DHS interactions among hospitalized DHS users. Of 927 patients who agreed to answer the questionnaire, 458 (49.4 %) reported the use of 89 different DHS. Potential DHS-DHS interactions were identified in 12.9 % of DHS users. Three interactions were associated with the actual occurrence of adverse events. Patients at risk of DHS-DHS interactions included females (p = 0.026) and patients with greater numbers of concomitant medications (p < 0.0001) and of consumed DHS (p < 0.0001). In 88.9 % of DHS users, DHS use was not reported in medical files and only 18 % of the DHS involved in interactions were documented. Potential DHS-DHS interactions are common in inpatients, and may lead to hospitalization or worsen existing medical conditions. The causal relationship between potential interactions and actual adverse events requires further study.

To Choose the Proper Antibiotic Regimen Between the Old and New Antimicrobial Agents and to Determine the Optimum Dosage with Bi-Digital O-Ring Test

Bi-Digital O-Ring Test (BDORT) can be used for various purposes for medical and dental diagnosis as well as for treatment purposes by determining the type of medication and the dosage for a patient. In case of infection, BDORT is a fast and non-invasive way to decide what kind of antibiotic and the dosage to be given to patient. If a patient already has been on a certain antibiotic for days, the clinician could use BDORT with diode (with arrow signs of the diode pointing to the patient) to test the same drug. Otherwise without diode, if BDORT result is negative, it could either mean the negative result might be due to resonance phenomenon or it may be because the antibiotic is ineffective. Either way, if O-Ring would be open during testing, the clinician should gradually increase or decrease the dosage of antibiotic to find out if BDORT result begins to become positive. In great majority of cases involving less effective old generation antibiotics, it is usually due to resistant microbia that require increasing dosage of antibiotic to make it become more effective. If increasing dosage would make O-Ring close, then the increased dosage would be effective to the patient. If the result is negative, the clinician should consider switching to another antibiotic regimen that may be tested positive with BDORT. Old generation antibiotics have not necessarily lost usefulness or lack efficacy on those new emerging resistant bacteria. Clinicians may just need to increase the dosage of those older generation antibiotics to make them more effective. In fact, with so many antibiotic-resisting strains of bacteria, clinician often face dilemma whether to switch to newer generation of antibiotics or just to increase the dosage of the older generation of antibiotics that a patient has been taking. When testing antibiotic of penicillin- related medication including amoxicillin, the thymus tablet (bovine source) should also be used for the testing after initially testing without it. Such a double checking system will avoid the false signal from BDORT about the drugs of penicillin family.

Valerian: no evidence for clinically relevant interactions

In recent popular publications as well as in widely used information websites directed to cancer patients, valerian is claimed to have a potential of adverse interactions with anticancer drugs. This questions its use as a safe replacement for, for example, benzodiazepines. A review on the interaction potential of preparations from valerian root (Valeriana officinalis L. root) was therefore conducted. A data base search and search in a clinical drug interaction data base were conducted. Thereafter, a systematic assessment of publications was performed. Seven in vitro studies on six CYP 450 isoenzymes, on p-glycoprotein, and on two UGT isoenzymes were identified. However, the methodological assessment of these studies did not support their suitability for the prediction of clinically relevant interactions. In addition, clinical studies on various valerian preparations did not reveal any relevant interaction potential concerning CYP 1A2, 2D6, 2E1, and 3A4. Available animal and human pharmacodynamic studies did not verify any interaction potential. The interaction potential of valerian preparations therefore seems to be low and thereby without clinical relevance. We conclude that there is no specific evidence questioning their safety, also in cancer patients.

Prevalence of diseases and conditions which impact on oral health and oral health self-care among older chilean

OBJECTIVE

The aim is to describe the prevalence of chronic diseases and conditions that may affect the oral health and oral health self-care of independent living Chilean older adults.

METHOD

In all, 4,766 residents aged 60 years and older took part in the study. Participants were interviewed using an 11-module instrument, including demographic data, quality of life, nutritional status, systemic diseases, and lists of medications.

RESULTS

Participants with cognitive impediments (n = 553) were eliminated from further analysis. Of the remaining 4,213, 61.2% were female. The mean age was 71.1 (SD = 7.8) years. A total of 19.6% reported no medical conditions, 53.1% reported one or two conditions, and 27.3% reported between three and nine conditions. The most commonly reported conditions were high blood pressure (78.0%), diabetes (26.5%), depression (23.4%), and cardiovascular disease (18.7%). Seventy-six percent reported taking medication, with an average of 3.4 drugs per person. Among those taking medication, 70.2% were taking at least one that may cause salivary hypofunction.

DISCUSSION

With the aging of Chile and the reciprocal links between oral disease and chronic diseases, policies and innovative initiatives need to be implemented so that programs become affordable and accessible for this population.