Effectiveness of photodynamic therapy adjunct to oral debridement in improving clinical, microbiological, and pain in necrotizing ulcerative gingivitis

To evaluate the efficacy of photodynamic therapy (PDT) as adjunctive to oral debridement (OD) in the improvement of clinical, microbiological, and pain in patients with necrotizing ulcerative gingivitis (NUG). Patients with NUG were split into two groups: Group-OD + PDT received PDT with OD, while Group-OD underwent OD alone. Clinical inflammatory parameters including full mouth plaque scores (FMPS), full mouth bleeding scores (FMBS), and probing depth (PD) were assessed. Fusobacterium nucleatum and Prevotella intermedia were analyzed using the polymerase chain reaction technique. Pain examination was done using various pain scales. Group PDT + OD showed more reduction in FMPS, FMBS, and greater reduction in F. nucleatum and P. intermedia count compared to group OD at 12 weeks follow up (p < 0.01). Group PDT + OD showed significantly lower pain scores at 12 weeks (p < 0.05). PDT was more effective in improving clinical parameters, and reducing bacterial counts and pain in NUG patients than dental scaling alone.

Effectiveness of photodynamic therapy on clinical and biomarker related periodontal parameters and oral health related quality of life (OHRQoL) in Parkinson's disease patients with stage III periodontitis

AIMS

To evaluate the clinical, radiographic, immune modulatory biomarkers and quality of life with the application of photodynamic therapy (PDT) as an adjunctive treatment to dental scaling and root planing (SRP) in patients with chronic periodontitis and Parkinson's disease.

METHODOLOGY

Individuals who had a confirmed diagnosis of stage III periodontitis and stage 4 Parkinson's disease according to Hoehn and Yahr scale were involved in this study. The participants were divided into two groups: Group SRP (n = 25) received traditional dental scaling procedure including full-mouth debridement and disinfection, and Group PDT + SRP (n = 25) received both traditional cleaning procedures along with adjunctive chloro‑aluminum phthalocyanine (CAPC) gel (0.005% concentration) mediated PDT. CAPC photosensitizer was activated using a diode laser (wavelength=640 nm, energy=4 J, 150 mW power, and overall power density of 300 J/cm2) for 60 s. The study measured clinical parameters such as plaque score (PI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), and radiographic alveolar bone loss (ABL). Proinflammatory cytokine levels such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) and oral health related quality of life were also assessed.

RESULTS

The mean age of patients in Group SRP was 73.3 years, while the mean age in Group PDT + SRP was 71.6 years. The PDT + SRP group showed a significant reduction in all clinical parameters at 6 and 12 months compared to the SRP group alone (p < 0.05). IL-6 and TNF-α levels were significantly reduced in the PDT + SRP group at 6 months compared to the SRP group alone (p < 0.05). However, at 12 months, both groups showed comparable TNF-α levels. The results showed that Group PDT + SRP had significantly lower OHIP scores compared to Group SRP, with a mean difference of 4.55 (95% confidence interval [CI]: 1.98 to 7.12) (p < 0.01).

CONCLUSION

Combined SRP with PDT showed significant improvement compared to SRP alone in terms of clinical parameters, cytokine levels, and oral health-related quality of life in individuals diagnosed with stage III periodontitis associated with Parkinson's disease.

Indocyanine-mediated antimicrobial photodynamic therapy promotes superior clinical effects in stage III and grade C chronic periodontitis among controlled and uncontrolled diabetes mellitus: A randomized controlled clinical trial

BACKGROUND

The aim of this randomized controlled clinical trial was to evaluate the efficacy of indocyanine-green mediated antimicrobial photodynamic therapy (ICG-aPDT) in the treatment of stage III grade C periodontitis in terms of clinical, microbiological, and immune-inflammatory parameters in patients with well-controlled and poorly-controlled form of type-2 diabetes mellitus (T2DM).

MATERIALS AND METHODS

Subjects with a diagnosis of chronic periodontitis according to the new classification and case definition of periodontitis [probing depth (PD): ≥6 mm, interdental clinical attachment loss (CAL): ≥5 mm and bone loss extending to mid-third of root and beyond (≥3 mm)] were recruited. Subjects were grouped on the basis of well-controlled and poorly-controlled diabetic status. Two subgroups were made according to the treatment modality (RSD versus ICG-aPDT/RSD) in each group. A split-mouth design was used in which one site was designated for control (RSD alone treatment) while the other contralateral site was chosen for test treatment (ICG-aPDT/RSD) in all the patients. Periodontal parameters included the measurement of plaque score (PS), bleeding on probing (BOP), probing depth (PD), clinical attachment level (CAL) and alveolar bone levels (ABL). Identification of Porphyromonas gingivalis and Tannarella forsythia through PCR was executed using species specific primers. Gingival crevicular fluid samples were then analyzed using enzyme-linked immunosorbent assay for the quantification of interleukin (IL)-17 and interferon (IFN)-γ. All the clinical, microbiological, and immunological parameters were assessed using repeated measure ANOVA for intra and inter-group comparisons. The p-value significance was set at 0.05.

RESULTS

The mean age of the 50 patients was 44.7 ± 7.4 years. Systemic parameters suggest no significant change between the times in either HbA1c or serum CRP levels in any of the groups. A statistically significant reduction for BOP was noted for ICG-aPDT group for non-diabetic subjects at 3 months follow up only, while a significant reduction was seen at both 3 months and 6 months among well-controlled and poorly-controlled T2DM subjects (p<0.05). For PD and CAL, a significant improvement was seen for ICG-aPDT group among non-diabetic and well-controlled T2DM subjects at both 3- and 6-months follow up, while a significant reduction was seen at only 3 months among poorly-controlled T2DM subjects. A significant reduction was seen for ICG-aPDT group compared to RSD group for both bacteria in all the three groups at 6 months follow up (p<0.05).

CONCLUSION

ICG-aPDT significantly improved clinical and antimicrobial parameters in well-controlled and poorly-controlled T2DM having stage III and grade C periodontitis. Glycemic status did not have negative impact in the reduction of periodontal parameters in either types of T2DM.

TRIAL REGISTRATION

The present RCT was registered in the clinicaltrials.gov under the identifier: NCT04857346.

Health-promoting lifestyle and its association with the academic achievements of medical students in Saudi Arabia

Objective:

This study aimed to assess health-promoting lifestyles among university medical students and to investigate whether such lifestyles are associated with students’ academic achievement.

Methods:

A cross-sectional descriptive investigative study was performed on 576 medical college students of King Saud University (KSU) in March 2019. Data were collected using the Health-Promoting Lifestyle Profile II (HPLP II) scale, which includes six dimensions (health responsibility, spiritual growth, physical activity, interpersonal relationships, nutrition, and stress management). The data were analyzed using descriptive and inferential statistics at a significance level of P < 0.05.

Results:

A mean score of 3.39 for total health-promoting behaviors was reported. The highest mean score was reported for spiritual growth (3.75) and the lowest was reported for health responsibility (3.23). The mean body mass index (BMI) of the students was 24.9 ± 6.4 kg/m². An analysis of variance identified an association between a student’s GPA and the spiritual growth dimension (P = 0.014). Based on the Pearson matrix correlation coefficient, there was a statistically significant and positive relationship between the HPLP II dimensions (P < 0.05).

Conclusion:

Since the HPLP scores were good, there is a need to enhance and promote healthy behaviors in students. The BMI data indicated that one-third of male students were overweight or obese; thus, health program planning, particularly involving physical activity and nutrition, is recommended.

Admission patterns and risk factors linked with neonatal mortality: A hospital-based retrospective study

Objective

This research was conducted to analyze the elements and factors that link with newborn deaths at Neonatal Intensive Care Unit (NICU) of a public teaching hospital in Jordan.

Methods

A retrospective study was conducted by reviewing the medical records of all the neonates admitted to the NICU over a one- year period from 1^st of March, 2018 to 28^th of February, 2019 at Princess Rahma Pediatric Hospital, Jordan.

Results

Overall, the medical records of 1247 neonates were included in this study. The common causes of admission were sepsis (27.3%), followed by respiratory distress syndrome (RDS) (24.9%) and asphyxia (13.1%). The majority of the admitted neonates survived (91.9%), and the overall mortality rate was 8.1%. According to the cause-specific death rate analysis, RDS was the most common cause of death rate (35.6%), followed by sepsis (27.7%). Logistic regression analysis results show that gestational age, weight of the baby at birth, and the quick clinical assessment (Apgar) within the first five minutes were the strongest predictors of neonatal mortality (P<0.05).

Conclusion

Sepsis, RDS, and asphyxia were the leading causes of morbidity in neonates. These diseases were also responsible for a high rate of mortality. Understanding the cause of morbidity and mortality of neonates admitted at NICU is useful for prioritizing and planning health services, re-allocating resources, and improving the quality of care.

Knowledge, practice and attitude about photodynamic therapy use among practicing nurses: A large scale cross-sectional data on implementation of photodynamic therapy education

BACKGROUND

The aim of this study was to assess knowledge, practice and attitude towards photodynamic therapy (PDT) among nurses of several medical colleges in Riyadh, Saudi Arabia. In addition, to appraise the implementation of PDT education in their clinical practice, we have conducted a large cohort cross-sectional study to identify their interest in PDT training, if they ever received one.

MATERIALS AND METHODS

A descriptive observational cross-sectional survey was conducted among the medical nurses in Riyadh city, Kingdom of Saudi Arabia. A questionnaire was formulated consisting of 20 items in five sections to assess knowledge, behavior, practice and attitude of medical nurses regarding PDT. To compare behavior, knowledge and clinical perceptions with knowledge score of nurses', spearman correlation coefficient was used.

RESULTS

A total of 225 participants completed questionnaires were analyzed. Most of the respondents demonstrated good knowledge. A cumulative 41 % of respondents agreed on the point when asked about 'awareness of the therapeutic significance of PDT'. Whereas, 61 % respondents answered to the option 'sometimes' when queried about 'do you endorse therapeutic choices of PDT to patient'. Moreover, 17 % respondents answered the option 'always' when questioned about 'do you recommend patients to consider PDT for skin melanoma, psoriasis, surgical excision, curettage and cryotherapy?' There were 26 % respondents who agreed to the question when inquired about 'how contented are you in knowing about PDT in clinical practice?'. Whereas, 93 % respondents showed their interest on hands on session on PDT. A majority of the respondents 41 % chose the option 'PDT is peripheral to my role as medical nurse.

CONCLUSION

Nurses demonstrated good knowledge related to PDT and modest awareness about the therapeutic significance of PDT. A high number of practicing nurse s showed interest for skilled PDT education seminars and workshops.

Difficulties Encountered by Final-Year Male Nursing Students in Their Internship Programmes

BACKGROUND

The cultural norms of the Kingdom of Saudi Arabia do not encourage men to choose nursing as a career. Understanding male nursing students' experiences of their clinical exposure to the nursing profession throughout their internship might increase their retention. This study explored the experiences of final-year male nursing students as they transitioned to the role of registered nurse.

METHODS

A qualitative descriptive research design with an inductive content-analysis approach was used. The experiences of 22 final-year male nursing students from three public hospitals in a major city of Saudi Arabia were explored. The data were collected using focus-group interviews and documentary analysis in March 2015 and May 2015.

RESULTS

Content analysis revealed three major themes: the societal and cultural image of male nurses, male students' engagement in nursing practice, and restructuring the internship programmes' policies to suit male students' needs.

CONCLUSION

The findings reveal issues that mainly stem from negative social views of nursing as a male profession. Considering the students' social and cultural needs during their internship programme will facilitate their transition into the role of registered nurse and their retention in the nursing profession.

Gap Analysis between Perceptions and Expectations of Medical-Surgical Patients in a Public Hospital in Saudi Arabia

OBJECTIVES

To investigate patients' satisfaction with nursing care by measuring the gap between patients' expectations of care and perceptions of the actual care provided and to identify the areas of nursing care that need improvement.

SUBJECTS AND METHODS

A cross-sectional survey was conducted among patients who were admitted to the Departments of Medicine and Surgery at King Saud Medical City, Riyadh, Saudi Arabia. A modified Service Quality (SERVQUAL) instrument was adapted to collect information from a convenience sample of 432 patients from November 25, 2012, to February 3, 2013. The instrument comprised 22 pairs of questions assessing 5 dimensions of the nursing care provided to patients during hospitalizations. The mean patient expectations and perceptions as well as the gap score values for each dimension of nursing service were tested for differences between the mean scores of the sample at a level of significance of 0.05 using a t test.

RESULTS

The gap score for all of the 5 dimensions of nursing services were: responsiveness, -1.71; reliability, -1.48; tangibles, -1.36; assurance, -1.26, and empathy, -0.96. Service quality across the dimensions of responsiveness and reliability was statistically significant (p < 0.05). This result indicated that patients were not satisfied with the nursing service quality in relation to all dimensions.

CONCLUSION

Our study showed negative gaps for the 5 nursing service quality dimensions evaluated. This could provide nurses with information about the aspects of nursing care that promote more positive patient outcomes and satisfaction.