Marginal and apical bone stability after staged sinus floor augmentation using bone condensing implants with variable-thread design: a two-dimensional analysis

Studies on the vertical stability of augmented bone after sinus lifting differ substantially. In addition, long healing periods are usually advocated prior to implant installation. The purpose of this case series study was to evaluate the changes in bone height after sinus lifting with a bovine-derived xenograft and to evaluate the clinical outcome of bone condensing implants installed after a short healing period. Patients treated during the years 2010-2013 were re-examined using peri-apical radiographs to evaluate the changes in augmented bone height (BH) and marginal bone loss (BL). Fifty-seven of 70 eligible subjects (28 male and 29 female, mean age 56 years) attended for reassessment. Data were available for 53 sinus lifts and 105 implants installed after a mean healing period of 4.6±1.5 months. Implant survival was 99% after a mean time in function of 19±9 months. Baseline BH, BH at implant placement, and final BH were on average 3.87±1.74mm, 13.75±2.12mm, and 13.11±2.12mm, respectively (P<0.001). Mean BL was 0.51±0.65mm. Only limited resorption is to be expected after sinus lifting in the short term. A bone condensing implant can be used in the early healing phase with successful outcomes in terms of implant survival and bone adaptation.

Treatment registry in focal epilepsy (TRIP): multicenter observational study in Lebanon

PURPOSE

Treatment of newly diagnosed epilepsy with a single antiepileptic drug (AED) is the favored approach for seizure management. This observational study aimed to assess, under daily practice conditions, remission and retention rates with the first AED prescribed as monotherapy in patients newly or recently diagnosed with focal epilepsy.

METHODS

The treatment registry in focal epilepsy (TRIP) study was conducted on 234 Lebanese patients with newly or recently diagnosed focal epilepsy, requiring treatment with an AED. Demographics, baseline focal seizure characteristics and results of the Clinical Global Impression (CGI) scale at the 12-month visit were reported. The primary objective of this study was to assess the percentage of patients who achieved a 6-month terminal seizure remission at the 12-month visit following treatment with a first AED administered as monotherapy. Secondary outcome variables included the calculation of the 6-month terminal seizure remission according to the baseline seizure types and patient retention at the 12 and 18 month visits. In addition, bivariate and multivariate analyses were conducted to identify independent predictors of 6-month terminal seizure remission at the 12-month visit.

RESULTS

The mean age of the 234 eligible patients was 31.6 years and the majority were males (62%). At baseline, the most common type of focal seizures was focal seizures with impairment of consciousness (45%), and the most frequent topographical localization was in the temporal lobe (47%). In total, 77.6% of the patients achieved a 6-month terminal seizure remission at the 12-month visit. Patients with an epileptogenic lesion on neuroimaging were significantly less likely to achieve a 6-month remission compared to those with no identifiable pathological substrate. Patients with focal motor seizures without impairment of consciousness at baseline had significantly lower odds of achieving a 6-month terminal seizure remission compared to patients with a combination of seizure types. There was no significant association between age or gender and 6-month terminal seizure remission. The retention rates were 95.7% and 88.5% at months 12 and 18 respectively with the great majority of patients (90.7%) reporting marked improvement on the CGI scale.

CONCLUSIONS

A substantial proportion of patients with newly diagnosed epilepsy achieved a 6-month terminal seizure remission following treatment with a first AED administered as monotherapy. Patients with an epileptogenic lesion on neuroimaging and those with focal motor seizures without impairment of consciousness at baseline were significantly less likely to achieve a 6-month terminal seizure remission. This study demonstrated the feasibility of conducting long-term multicenter studies in Lebanon and will hopefully serve as an impetus to conduct randomized studies in the field of epilepsy.

Identifying predictors of blood pressure control in the Lebanese population - a national, multicentric survey -- I-PREDICT

BACKGROUND

Blood Pressure (BP) is not well controlled and factors that predict BP control are not well identified in Lebanon. Improvement of hypertension management requires an understanding of patients' characteristics and factors associated with uncontrolled BP. This national, multicentric, observational prospective study was designed to determine the predictors of BP control in patients followed up to 6 months.

METHODS

I-PREDICT study was conducted on 988 patients with newly diagnosed or uncontrolled hypertension. Socio-demographic and clinical characteristics were analyzed. The level of agreement between doctors' perceptions on BP control status and JNC VII guidelines was analyzed.

RESULTS

The predictor associated with poor BP control was diabetes (OR = 0.17, CI = 0.10-0.28 at month-1; OR = 0.15, CI = 0.10-0.24 at month-6). The predictors associated with better BP control at month-6 were the early control of BP at month-1 (OR = 10.39, CI = 6.18-17.47) and combination therapy prescribed at baseline and month-1 (OR = 15.14, CI = 1.09-208.46, P = 0.04). In the sub-group of diabetes, the predictors that were associated with better BP control at 6 months were following diet at V1 (OR = 2.27, CI = 1.01 to 5.12) and BP control at V2 (OR = 7.34, CT = 3.83 to 14.07). The predictors that were associated with poor BP control at 6 months were middle economic class (OR = 0.036, CI = 0.16-0.94) and upper economic class (OR = 0.036; CI = 0.13-0.93).The rate of BP control was significantly higher at month 6 versus month 1 (67.52% vs 44.08%, P = 0.001). Additional analysis showed poor agreement between the doctors' perceptions on BP control status and the guidelines.

CONCLUSIONS

Reaching an early BP control and combination therapy were significant predictors of better BP control, whereas diabetes was a significant predictor of poor BP control. A poor agreement between JNC VII guidelines and clinical practice was observed. I-PREDICT study identified factors that can be targeted for improving BP control.

Dental implants placed by undergraduate students: clinical outcomes and patients'/students' perceptions

INTRODUCTION

Implant dentistry in undergraduate education is predominantly theoretical or prosthetics oriented. Clinical experience with implant surgery could provide students a better understanding of alternatives for tooth replacements. This study describes an implant dentistry programme for undergraduate students, which included surgical placement of implants. The study presents the clinical outcomes of the programme, patients' satisfaction and students' attitudes/perceptions. It reflects on barriers and problems encountered during implementation and provides suggestions for other institutions.

MATERIALS AND METHODS

Thirty-six students placed one implant each for a single tooth replacement after careful radiographic assessment and pre-surgical planning. One-stage surgery was performed under one-to-one supervision. Crowns were cemented on individual abutments 3-6 months later. Crestal bone loss was assessed radiographically immediately after surgery, at crown placement and after 1 year of loading. Questionnaires were used to investigate patients' perspectives and students' opinions towards the programme, as well as their perceived level of competence.

RESULTS

Thirty-six implants were placed in 27 patients; two (5.6%) failed prior to loading; mean bone loss from time of surgery to crown placement was 1.41 mm and remained unchanged thereafter, reflecting implant success. Overall, patients were satisfied and the majority would repeat the treatment by a student. The students thought it was a valuable experience, although they realised that additional education is necessary to perform implant surgery without supervision.

CONCLUSION

Implant placement by undergraduate students resulted in acceptable clinical outcome parameters, patient satisfaction and positive student perceptions. These findings support the further development of clinical implant education in undergraduate dental curricula.

Management and control of patients with type 2 diabetes mellitus in Lebanon: results from the International Diabetes Management Practices Study (IDMPS)

BACKGROUND

The IDMPS is a study to identify changes in diabetes treatment practice in several developing countries. This paper focuses on diabetes management and compliance with guidelines in a Middle Eastern country like Lebanon.

METHODS

The cross-sectional data from the 2006 wave of two weeks duration on the Lebanese population along with the longitudinal data of a 9-month follow-up study were collected.

RESULTS

A large proportion of Lebanese patients were not adequately controlled or followed up. A slight proportion was managed by diet and exercise alone while most patients were on two or more oral anti-hyperglycemics. Metformin was the most common monotherapy followed by sulfonylureas. 22.6% of Lebanese patients were on insulin, most commonly basal insulin alone followed by premix insulin alone. Blood glucose self-monitoring was more frequently done by insulinized patients and was associated with better glycemic control. Glycemic control was reached in 29.6% of type 2 patients (HbA1c < 7%) with poorest outcome for patients on insulin and was more frequently achieved in patients who had more frequent monitoring of HbA1c levels.

CONCLUSION

For a proper assessment of diabetic control, maintaining adherence to international guidelines needs to be evaluated. Promoting patient education, improving physician knowledge with better implementation of guidelines is recommended.

Sequential vinorelbine–capecitabine followed by docetaxel in advanced breast cancer: long-term results of a pilot phase II trial

PURPOSE

To evaluate the response rate of the combination of capecitabine (C) and vinorelbine (V) followed by Docetaxel (D) in the 1st line treatment of advanced and metastatic breast cancer patients.

PATIENTS AND METHODS

Patients with measurable disease and no prior chemotherapy in advanced disease were eligible. Pts received V 25 mg/m(2) on day 1 and 8 in combination with C 825 mg/m(2) twice a day from day 1 to 14 every 3 weeks for four cycles followed by 12 consecutive weeks of D 25 mg/m(2)/w.

RESULTS

Between March 2002 and November 2003, 40 patients were enrolled. Median age was 57 years. Of patients, 77.5% of pts had visceral involvement and 32.5% had more than two metastatic sites. In the adjuvant setting, 62.5% received anthracycline and 10% Taxanes. In the intent-to-treat population, an overall objective response was observed in 25 patients (62.5, 95% CI, 45.8-77.27) and stable disease in 5 (12.5%). Median time till progression (TTP) was 12.3 months (range 1.5-48; 95% CI, 10.05-14.54). The median survival was 35.7 months (range 2-47). Reported grade 3-4 toxicities under Navcap were neutropenia (4 pts), anemia (1 pt), thrombopenia (1 pt) and febrile neutropenia (3 pts). Reported grade 3-4 toxicities under weekly Docetaxel were neutropenia (1 pt), thrombopenia (2 pts), leucopenia (1 pt) and anemia (1 pt).

CONCLUSION

The sequential use of Navcap followed by weekly Docetaxel demonstrated an interesting efficacy with a prolonged TTP and OS and warrants further evaluation.

FOLFOX-6 combination as the first-line treatment of locally advanced and/or metastatic pancreatic cancer

OBJECTIVE

Advanced pancreatic carcinoma (APC) has a poor prognosis and chemotherapy remains the most common approach. Gemcitabine was the only drug recently approved for use as single agent therapy in APC. However, the combination of oxaliplatin and 5-fluorouracil (5-FU) has shown some promising results. This phase II trial was conducted to investigate the efficacy of oxaliplatin, 5-FU, and folinic acid (FOLFOX-6) in previously untreated APC patients.

METHODS

We studied response rate, time to progression, and toxicity profile. Treatment included oxaliplatin 100 mg/m2 and folinic acid 400 mg/m2 on day 1 followed by a 5-FU bolus 400 mg/m2 and a 46-hour infusion of 3000 mg/m2 every 2 weeks.

RESULTS

From January 2003 through December 2004, 30 eligible patients were included. Median age was 65 (range, 38-75). There were 22 patients who had metastatic disease and 29 had an adenocarcinoma. A total of 181 cycles were delivered with a mean of 6 cycles per patient. There were 23 patients evaluable for response. There were 8 patients with partial response (27.6% response rate) and 10 with stable disease status (34.5%), while tumor growth control was found in 62% of the patients. Recorded toxicities of grade 3/4 were: neutropenia (26.67%), thrombocytopenia and anemia (10% each), diarrhea (6.67%), and mucositis (3.33%). Neurosensory toxicity was mild. The median time to progression and the median survival were 4 and 7.5 months, respectively.

CONCLUSION

In patients with APC, FOLFOX-6 regimen achieved an interesting response rate within a tolerable level of toxicity. This regimen seems to warrant further controlled investigation to confirm its efficacy.

Preliminary results of phase II study of irinotecan and capecitabine combination as first line chemotherapy for advanced and metastatic gastric cancer

14030

Background: Chemotherapy has a proven palliative role in advanced gastric cancer. The most widely investigated single-agent chemotherapy is 5-fluorouracil with partial response rates up to 20%. Single-agent irinotecan achieved response rates of 18%-23%. We investigated the combination Irinotecan plus Capecitabine for previously untreated locally advanced or metastatic gastric cancer. Methods: We conducted a phase II study with the combination of Irinotecan 80 mg/m2 on day 1, 8, and 15, and capecitabine 625 mg/m2 twice daily on days 1 to 14 repeated every 4 weeks. Patients were evaluated every second cycle. Previous chemotherapy for metastatic disease was not allowed. Patients must have measurable disease, ECOG PS < 2, life expectancy > 2 months, adequate hematological, liver and renal functions. Response was evaluated according to RECIST and toxicities according to NCI common toxicity criteria 3.0. Results: Between February 2002 and December 2005 31 patients were enrolled (20 male and 11 female). The median age was 57 years [range 37–74 years]. 142 cycles were administered with a median of 4.6 cycles per patient [range 1–10 cycles]. 29 patients were evaluable for response, and two are on ongoing treatment. Partial response rate was 38.5% . 9 patients (29%) had stable disease. Overall tumor control rate was 67.5%. Median time to progression and overall survival were 5.8 months [range- 1–16] and 10.58 months [range- 1–21] respectively. There was no grade III-IV reported toxicity including no hand and foot syndrome. Conclusions: Irinotecan and capecitabine in combination show an interesting tumor control rate (67.5%) with extremely well tolerated toxicity in patients with extensive gastric cancer.

No significant financial relationships to disclose.

Preliminary results of second-line chemotherapy with vinorelbine and gemcitabine after docetaxel and carboplatin failure in advanced non small cell lung cancer (NSCLC)

17130

Background: To evaluate the efficacy and safety of a doublet platinum-free therapy based on Vinorelbine and Gemcitabine in the salvage treatment of patients with advanced NSCLC, previously treated with Carboplatin and Docetaxel. Methods: We conducted a phase II study with the combination of vinorelbine 30 mg/m2 and gemcitabine 1000 mg/m2 d1 d8 / 3w. Eligible were patients with histologically proven advanced or metastatic NSCLC who were refractory or progressed after first-line chemotherapy combining Docetaxel and Carboplatin. Results of this first-line therapy were already reported (Proc. Am. Soc. Clin. Oncol. 2005, abstr 7330). Patients must have measurable disease, PS ≤ 2, life-expectancy ≥ 3 months, adequate hematologic, liver and renal functions. Response to therapy was evaluated according to RECIST guidelines. Toxicities were assessed according to the national cancer institute (NCI) common toxicity criteria 3.0. Results: From August 2004 to September 2005, 28 patients were enrolled. Median age was 63 years (range, 44 to 77) with 18 males and 10 females. A total of 109 cycles were delivered with a median of 4 cycles per patient (range, 1 to 9). Mean metastatic sites were lymph nodes in 9 pts, liver in 6 pts and pleura in 5 pts. 26 patients were evaluable for response (1 patient too early and 1 pt lost of follow-up). 6 patients responded partially (23%), one of them was initially resistant to the first-line therapy. 11 patients had stable disease (42%). Mean objective response duration was 7 months (range, 5 to 10+). Main toxicities (grade 3/4) were: anemia in 4 patients, neutropenia in 7 patients, leucopenia in 8 patients and lymphopenia in 4 patients. Neutropenic fever was encountered in only one patient. Non-hematological toxicities grade 3/4 were universally absent. No dose reduction or treatment delay related to toxicity was necessary. Conclusion: The study is still ongoing and more patients are expected to define time to progression and survival. However, these preliminary results were encouraging with low toxicity profile.

No significant financial relationships to disclose.

Capecitabine and irinotecan in elderly patients with advanced or metastatic gastro-intestinal tumors

18619

Background: Capecitabine and Irinotecan exhibit single-agent activity in gastro-intestinal tumors. Their combination seems safe and effective. Adult patients with advanced or metastatic gastric or colorectal cancers were enrolled separately in 2 phase II trials dealing with the combination of both drugs. The aim of this study was to evaluate retrospectively the toxicities and the safety profile of this combination in elderly patients (≥ 65 years) as first line therapy for advanced or metastatic gastro-intestinal cancers. Methods: Patients with advanced or metastatic adenocarcinomas of the colon or the stomach aged 65 years or more were treated with the combination of: Irinotecan 80 mg/m2 IV d1,8,15, and Capecitabine 1250 mg/m2 orally d 1–14, Q 4w. Toxicities were graded according to the NCI common toxicities criteria version 3. Results: 24 naïve-chemotherapy patients were included. Median age was 68 years (extremes 65 to 88). Primary tumor was stomach, colon, and rectum in 13, 9, and 2 cases respectively. Frequent sites of metastases were liver (18), lymph nodes (8), peritoneum (7), and lung (5). They received 113 cycles with median number 4.7/patient, and extremes 1 to 14. Serious toxicities graded as IV were universally absent. Grade III anemia, diarrhea, and vomiting were encountered in 1, 1, and 2 patients respectively. Grade II anemia, leucopenia, diarrhea, alopecia, fatigue, and vomiting were recorded in 5, 2, 4, 2, 2, and 6 patients respectively. Hand-foot syndrome was observed as only grade I in 2 patients. There was no febrile neutropenia. In the other hand, objective response was encountered in 9 patients (37.5%), with median response duration of 6 months (extremes 1 to 15). After a median follow-up of 36 months, 19 patients died from progression of their disease with mean overall survival of 5.5 months (extremes 1 to 28). Conclusion: The combination of Irinotecan and Capecitabine according to our schedule revealed an excellent safety profile with easily manageable toxicities. This schedule is highly suitable for elderly patients.

No significant financial relationships to disclose.

Gemcitabine and pegylated liposomal doxorubicin as salvage therapy in metastatic breast cancer (MBC)

10645

Background: Doxorubicin and Taxanes are the most used drugs in front-line therapy for MBC. Patients with progressive disease refractory to these drugs are candidate to different salvage regimens. We investigated the combination of gemcitabine and pegylated liposomal doxorubicin as salvage option for these patients. Methods: This phase II study included gemcitabine (Gemzar) 1000 mg/m2 day 1, day 8 and pegylated liposomal doxorubicin (Caelyx) 25 mg/ m2 day 1 every 21 days. Inclusion criteria included measurable disease, performance status <2 according to the Zubrod scale, and no prior Gemzar or Caelyx treatment. Patients had to have one line of chemotherapy for metastatic disease. Responses were evaluated according to the RECIST criteria. Study Objectives were response rate, time to progression, and toxicity profile. Results: Between March 2003 and September 2005, 30 patients were enrolled. Mean age was 54 years [32–72]. 22 patients had two or more metastatic sites. Mean metastatic sites were liver (17), bone (12), lung (10) and pleura (5). 26 patients have had prior taxane treatment, and 21 prior anthracyclines. 144 cycles were delivered with a median of 6 per patient. There were 13 partial response, 11 stable disease, 5 progression and 1 unknown. Overall response rate was 43% with median response duration of 7 months (4–20+). 12 among the 13 objective responses were noted at visceral sites. During follow-up, 14 patients died. Median Survival time was 7 months. Median Time to progression was 7 months [0.5–20+]. The most encountered grade 3 or 4 toxicities were anemia in 5 pts, thrombopenia in one pt, neutropenia in 7 pts, neutropenic fever in 2 pts, hand-foot syndrome in 4 pts and stomatitis in 3 pts. No cardiotoxicity was noted. Conclusion: Salvage therapy for MBC could be successfully achieved by the combination of Gemcitabine and Pegylated liposomal doxorubicin (43% OR) according to our schedule. The tolerability was also acceptable. This schedule warrants further investigation.

No significant financial relationships to disclose.

Phase II trial of capecitabine and vinorelbine as first-line chemotherapy for metastatic breast cancer patients

BACKGROUND

Vinorelbine is one of the most active cytotoxic agents in metastatic breast cancer. Its association with 5-Fluorouracil generates objective responses, varying between 44 and 55%, and improves the tolerance profile. The aim of this multicenter phase II trial was to assess the combination of capecitabine and vinorelbine as first-line chemotherapy in patients with metastatic breast cancer (MBC).

PATIENTS AND METHODS

Thirty patients with MBC received a 3-week cycle combining capecitabine 825 mg/m2 twice a day on days 1 through 14, with 25 mg/m2 of vinorelbine on days 1 and 8. Treatment continued until progression, unacceptable toxicity or patient refusal to continue. The median age was 54 years (30-77) and the median WHO-PS was 1. Twenty patients (67%) received adjuvant chemotherapy including anthracycline and taxanes.

RESULTS

Objective responses occurred in 21 patients (70%). Stable disease lasting more than 6 months was observed in six patients (20%). The clinical benefit rate was 90%. The median progression-free survival and overall survival were 10 months and 30.4 months, respectively. The most frequent treatment-related toxicities were: WHO grades 3 and 4 neutropenia (two patients), febrile neutropenia (two patients), grade 3 asthenia (two patients) and grade 3 nausea/vomiting (one patient). No grade 3 hand-foot syndrome was observed.

CONCLUSION

The combination of capecitabine and vinorelbine is an active and safe regimen for first-line treatment of MBC.

Drug-related hospitalization at a tertiary teaching center in Lebanon: incidence, associations, and relation to self-medicating behavior

OBJECTIVE

In Lebanon there is very limited restriction on drug use. Accordingly, self-medication is highly prevalent. This study examined the influence of these factors on the development of drug-related illnesses that lead to hospitalization.

METHODS

Patients admitted to the medical and pediatric wards of a tertiary teaching center in Beirut, Lebanon, over a period of 6 months were interviewed and their charts were reviewed. Admissions attributable to adverse drug reactions or therapeutic failures were identified and characterized with respect to demographic factors, medical history, drug intake, and self-medicating behavior. The influence of these variables on the development of drug-related illnesses was examined by logistic regression.

RESULTS

Of 1745 adults and 457 children, there were 177 (10.2%) and 36 (7.9%) drug-related illnesses, respectively. Adverse drug reactions accounted for 7.0% and 5.7% and therapeutic failures for 3.2% and 2.2% of adult and pediatric admissions, respectively. Self-medication was commonly practiced (52.6% of adults and 41.6% of children). Logistic regression analysis revealed that female sex increased the risk of adverse drug reaction in adults, whereas self-medication decreased the risk. In children, the risk of adverse drug reaction was increased in lower socioeconomic groups, whereas the risk of therapeutic failure was increased by a positive history of atopy or drug reaction.

CONCLUSIONS

These results provide the first detailed analysis of the problem of drug-related illnesses in a developing country and identify a number of related or risk factors. Despite the lack of regulation of drug dispensing and the unchecked access to drugs in Lebanon, the incidence of drug-related illnesses is not different from that in Western nations. This finding may have relevance to policies of drug regulation in other countries.

Expression of TNF and the 55-kDa TNF receptor in epidermis, oral mucosa, lichen planus and squamous cell carcinoma

TNF has diverse biological effects including a role in the immune response and growth regulatory effects.

OBJECTIVES

The aim of this study was to determine the nature and location of cells able to synthesise and respond to TNF in oral mucosa in health and disease.

MATERIALS AND METHODS

The location of immunoreactive TNF and 55-kDa and 75-kDa TNF receptors was demonstrated using immunohistology. We also used RT-PCR to help determine the sites of synthesis of this cytokine in oral mucosa.

RESULTS

Only occasional TNF-positive cells were detected in normal epidermis and oral mucosa. However, this cytokine was found throughout the epithelia in oral lichen planus, leukoplakia and squamous cell carcinoma (SCC). The possible cellular sources and biological effects of TNF in these disease processes is discussed. The 55-kDa TNFR was expressed at the cell membrane throughout the epidermis, but confined to the lower cell layers on oral mucosa. Ten of 22 SCC did not express this receptor. A significant correlation was observed between the velocity of tumour growth and absence of TNF receptors.

CONCLUSIONS

The growth inhibitory and immunoregulatory effects of TNF may be modulated by changes in receptor expression and alterations in synthesis of this cytokine in a subgroup of oral SCC.