Faculty Bibliography

Background: Forensic odontology, a branch of dentistry includes identification of individuals in various crime scenes, natural calamities, and mass disasters. The identification is possible because every individual body is unique and so is our tongue due to its morphological variations. The primary objective of the study was to assess the morphological features of the tongue and its use in sex determination.
Method(s): The study included a sample size of 100 individuals (50 males and 50 females) in the age range of 20-50 years old. Photographs were taken of front and side view of the tongue; visual inspection was done and lastly impressions of the tongue were made with help of alginate and then poured with the help of dental stone. IBM SPSS statistics 20.0 (IBM Corporation, Armonk, NY, USA) was used for the analyses of the data. Microsoft word and Excel were used to generate graphs, tables etc. Females presented with triangular shape, presence of shallow fissures more commonly and a sharp lingual apex of tongue. Males presented with rectangular shape, presence of deep fissure/absence of fissures more commonly and septate/ sharp lingual apex of the tongue.
Conclusion(s): Tongue exhibits various unique characteristics and can be used in sex determination.
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Background: Proton-pump inhibitors (PPIs) remain the leading evidence-based therapy for upper gastrointestinal disorders. The effectiveness of PPIs has led to overutilization, exposing patients to an increasing number of potential risks. Despite FDA safety warnings regarding the potential adverse effects of long-term PPI use, there has been a failure to re-evaluate the need for continued therapy. The VA Manhattan outpatient Geriatrics clinic, in collaboration with pharmacists and patients, conducted a quality improvement (QI) program using a shared decision-making approach to deprescribe inappropriate PPIs.
Method(s): Patients with PPIs ordered from April, 2017 to April, 2018 were identified using the VA database. Diagnoses were identified using ICD 10 codes. Patients without a clear indication for longterm PPI treatment were identified (long term PPI use is indicated in refractory GERD, Barrett's esophagus, Zollinger-Ellison syndrome, idiopathic chronic peptic ulcer, and bleeding prevention in selected patients). Patients were contacted telephonically by a physician or pharmacist, counseled regarding adverse effects of long-term PPI use and offered titration/discontinuation or change to an alternative agent. If patients consented, they were contacted for follow-up interviews at 1, 3, 6, 12 months after inclusion to assess symptoms and tolerance.
Result(s): Of the1230 patients in the Geriatrics clinic, 74 (6%) were on PPIs. Of these, 41/74 (55%) had no indication for chronic PPI use. 36 of 41 patients consented to participate. We were able to titrate and discontinue or switch to an H2 antagonist in 20 (55%) of the 36 patients but 15 (42%) were restarted on PPI for recurrence of GERD symptoms over the 12 months of follow-up. 1 patient died of natural causes.
Conclusion(s): This QI program successfully deprescribed inappropriate long-term PPIs in some patients without major adverse events by using an interdisciplinary approach and shared decision- making process with patients. However, a sizable proportion of patients required restarting of a PPI for GERD symptoms. Future work is needed to understand if GERD symptom control can be achieved by other means to further decrease PPI use