We investigated the natural course of subclinical thyroid dysfunctions in geriatric patients, especially regarding their association with mortality rate. Ninety-three randomly selected chronically ill geriatric patients 64- 87 (median: 77) yr of age participated in the screening study with a 2-yr follow-up. Serum thyrotropin (thyroid- stimulating hormone [TSH]), free thyroxine, triiodothyronine, and antibodies against thyroid peroxidase were measured. During the follow-up, patients with suppressed TSH levels who were otherwise euthyroid (untreated) had a higher mortality rate than patients with normal TSH (5/8 vs 18/64; p < 0.05). The initial clinical state of these two subgroups did not differ significantly. Two-thirds of patients with treated hyperthyroidism died. The mortality rate of patients with initially subnormal but not suppressed TSH level was average and did not differ statistically from either the euthyroid or the hyperthyroid groups. Only 1 of 13 euthyroid patients with positive thyroid antibody titers developed a subsequent subclinical hypothyroidism. Subclinical hyperthyroidism was found to be associated with a higher mortality rate in chronically ill geriatric patients, which justifies screening for thyroid dysfunction and treatment of subclinical hyperthyroidism. In addition, a subnormal but measurable TSH was not indicative regarding the future development of hyperthyroidism. Finally, during the 2-yr follow-up, antibody positivity in the euthyroid cases did not prove to be predictive for the subsequent development of hypothyroidism.

We investigated whether the blood spot thyrotropin (TSH) method was adequate for screening elderly subjects with abundant iodine intake (median excretion 330 microg/g creatinine) for hypothyroidism. In 97 healthy adults (group A), 210 nursing home residents (group B) and 265 elderly subjects living at home (group C) serum (sensitivity < 0.02 mU/L, cost 1.2 U.S. dollars [USD]) and blood spot TSH (sensitivity < 1.0 mU/L, cost 0.4 USD) were measured, and the sensitivity and specificity of different blood spot TSH cutoff points to detect cases with elevated serum TSH were calculated. Elevated (> 3.5 mU/L) serum TSH levels (group A, 6.2%; group B, 16.2%; group C, 22.3%; B > A, p = 0.025; C > A, p < 0.001) were detected with the required sensitivity of greater than 0.9 only if the cutoff point of the blood spot TSH was set as low as 2.5 mU/L, but this led to a considerable loss of specificity. At cutoff point 2.5 mU/L, the rate of positivity was 39.3% and the cost of blood spot screening/person increased to 0.88 USD, considering that positive cases have to be rechecked by serum TSH to exclude false positivity. Cases with significantly elevated (> 10.0 mU/L) serum TSH (group A, 1.03%; group B, 2.85%; group C, 2.20%) were detected at blood spot cutoff points 10.0-4.0 mU/L with a sensitivity of 1.0 and without considerable loss of specificity. We conclude that while screening for hypothyroidism in the elderly population with abundant iodine intake is justified by the high prevalence of elevated ultrasensitive serum TSH values, the sensitivity of the blood spot method is insufficient to detect the subclinical hypothyroidism accurately and would, therefore, fail to detect most affected subjects.

Background: Dental treatment under general anaesthesia for children is a useful option in behaviour management. However, this treatment modality may also be accompanied by considerable postoperative pain. We aimed to specify factors related to postoperative pain and those that alleviate complaints. Methods: Children treated in general anaesthesia and their parents voluntarily participated in the study. Pain was reported daily by children using Wong Baker FACES Pain Rating Scale and by caregivers, using a yes/no questionnaire during hospitalization and throughout the postoperative week. The relation of patient and operation linked factors were evaluated in accordance with the duration and severity of pain. Results: Based on children’s responses and parental feedback, no significant difference was found in pain level between extraction and non-extraction cases. Intraoperative local anaesthesia did not influence pain during hospitalization. Compared to other analgesics postoperative intravenous opioid administration was more effective in pain management. Older patients reported more durable and severe pain during the postoperative week. Treatment time, airway management and the class of extracted primary tooth (molar, anterior) significantly influenced pain during postoperative week. Additionally, parental questionnaires revealed correlation between gender and postoperative pain.Conclusion: Few of the influencing factors are alterable, but with precise and meticulous treatment planning postoperative pain, thereby the distress on families may be reduced.

A temporomandibuláris rendellenességek (Temporomandibular Disorders, TMD) a fogorvostudomány komoly kihívástjelentő, magas prevalenciát mutató betegségcsoportja. A szakemberek között a mai napig sincs teljes egyetértés a TMDetiológiája, klasszifikációja és kezelése kapcsán, ugyanakkor a páciensek alapvető érdeke, hogy betegségükkel kapcsolatbanvalid kutatási eredmények szülessenek. A TMD diagnosztikája jelentős fejlődésen ment keresztül az elmúlt évtizedekben.A Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) egy 2014-ben publikált, kutatási és klinikaifelhasználásra egyaránt alkalmas rendszer, mely megfelel a bizonyítékokon alapuló orvoslás kritériumainak. A PTE Fogászatiés Szájsebészeti Klinikán felállt kutatócsoport elkészítette a DC/TMD magyar nyelvű változatát, ezzel lehetővétéve a hazai szakemberek számára, hogy egy nemzetközileg elfogadott diagnosztikus eszközt használhassanak. A cikkbemutatja a DC/TMD-t és részletezi a munkacsoportunk által végzett fordítási-adaptációs folyamatot.