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Medically Compromised Patients

Managing a patient with HIV

This summary is an adaptation of the e-Therapeutics Evaluation published by the Canadian Pharmacists Association (CPhA): Infectious Diseases: HIV Infection Investigations Clinical History Risk behaviours, social support and need for counselling Establish date of infection, if possible, based on a review of past sexual contacts, period of needle sharing, receipt of blood or blood products, availability of a previous negative test or a history of possible seroconversion illness (e.g., mononucleosis-like or severe flu-like illness) shortly after a high-risk exposure General indicators: anorexia, weight loss, fatigue or malaise, lymphadenopathy Symptoms of opportunistic infections, e.g., fever, night sweats, cough, dyspnea, diarrhea, headache ...

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From the trenches: How to “dodge the bullet” and make the right diagnosis?

This case was submitted by Dr. Ron Kellen  This situation occurred about 20 years ago. My office was in a plaza, on the second floor, requiring 26 steps to access it, with no elevator. At about 2 PM on a weekday, a 60-year-old male patient presented in our office as an emergency case with a terrible toothache. He pointed to his broken 35. On his medical questionnaire, he indicated that he had a little bit of high blood pressure and that he sometimes would get out of breath. He was taking medication once a day for blood pressure, but he ...

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Managing severe Alzheimer disease: what are the evidence-based guidelines?

This summary is based on the guidelines published by the Canadian Medical Association (CMA): Diagnosis and treatment of dementia: 6. Management of severe Alzheimer disease. The article was retrieved from the CMA Infobase: Clinical Practice Guidelines Database (CPGs) Access the article here (PDF) Context The management of severe Alzheimer disease often presents difficult choices for clinicians and families. The disease is characterized by a need for full-time care and assistance with basic activities of daily living. The authors outline an evidence-based approach for these choices based on recommendations from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. The authors developed evidence-based guidelines using systematic literature searches, ...

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How do I protect my patient medically, while safely providing the required treatment?

This case was submitted by Dr. Ron Kellen  Case Details Male patient, 55.  Diagnosed with AIDS in 2/2013 – at which time, CD4 count was 50. Now he says his CD4 count is 200. On Methadone (on-off for 10 years now). Ex heroin IV, and oxycontin, Percocet, etc. narcotics. On anti-convulsive for grand mal seizures. No more seizures since started medications. Smokes medical marijuana to increase his appetite. He is very underweight. On effective AIDS cocktail since Feb, 2013  Just finished thrush treatment of Nystatin swish & swallow (from G.P., not AIDS MD).  Still remnants clearly visible He has only ...

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How would you treat a patient with neuropathic orofacial pain?

This summary is based on the article published in the Journal of the American Dental Association: Dental treatment for patients with neuropathic orofacial pain (September 2013) Clinical Case A 56-year-old woman visited a dental office with acute dental pain in the left mandibular molar area. The treating dentist established a diagnosis of trigeminal neuralgia (TN) related to the left V3 branch, for which the patient was treated with nerve membrane–stabilizing anticonvulsants. The patient’s medical history included mild hypertension, hypothyroidism and intermittent low back pain for which she was being treated adequately by her physician.  The clinical examination revealed the left mandibular permanent first molar (tooth ...

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What are the clinical considerations for dental implant therapy in irradiated head and neck cancer patients?

This summary is based on the article published in the Journal of Prosthodontics: Updated Clinical Considerations for Dental Implant Therapy in Irradiated Head and Neck Cancer Patients (August 2013) Context An increasing number of reports indicate successful use of dental implants (DI) during oral rehabilitation for head and neck cancer patients undergoing tumor surgery and radiation therapy. Implant-supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy. However, negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated ...

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Are there underlying psychological factors for tooth wear?

This summary is based on the article published in Special Care in Dentistry: The psychology of tooth wear (January/February 2013) Context Tooth wear, also referred to as tooth surface loss (TSL) or non-carious TSL, has been defined as the “pathological loss of tooth tissue by a disease process other than dental caries”. The etiological factors of tooth wear include attrition, erosion and/or abrasion. Purpose of the Study Review the main psychological and mental conditions that are manifested dentally in the form of tooth wear. These conditions include depression, eating disorders, and alcohol and drug use disorders. Review the comorbidity of ...

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Are there adverse drug reactions to local anesthetics?

This summary is based on the article published in the Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology journal: Adverse drug reactions to local anesthetics: a systematic review (March 2013) Context  Local anesthetics (LAs) are widely used, especially in oral and ophthalmologic treatments. The types, doses, means of administration of LAs, and combined drugs are the main factors that could induce adverse drug reactions. Purpose of the Review Analyze adverse drug reactions (ADRs) associated with local anesthetics (LAs) and to characterize the safety profile of LAs in clinical application. Results A total of 922 articles were retrieved, and 101 of them, containing 1,645 events, ...

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