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A letter to the editor in response to the article "Major psychological complications and decreased health-related quality of life among survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis," that was published in a previous issue of the journal is presented.

Dental displacement, an obligatory state for a good result of an orthodontic treatment, is obtained by bone resorption and apposition, resulting from an inflammatory process localized at this level. Lymphocytes produce a large number of peptides with regulatory functions upon the organism in autocrine, paracrine or at high distance (endocrine) ways. These peptides were described as cytokines. Among these, interleukin 1β and interleukin 8 are the main proinflammatory cytokines, and they can be use as inflammation markers. In these conditions, the objective of this paper is the assessment of the IL β and IL-8 levels in the gingival crevicular fluid of the orthodontic tractioned teeth compared to the teeth upon which no orthodontic force is applied, before as well as after the device application. The patients taken into this study were 12 girls and 6 boys, between 7 and 12 years, average age of 9.3 years, who exhibited an orthodontic tooth movement of a single tooth (experimental tooth), the homonym tooth from the antagonistic arcade being considered as control. The gingival fluid was sampled before the beginning of the treatment, and after 1 hour, 24 hours and 7 days from the device application. The levels of IL-1β and IL-8 in the gingival crevicular fluid was assessed by ELISA technique. The level of the two pro-inflammatory interleukins in the gingival fluid of the tractioned teeth was significantly higher (p<0,01) at 24 hours from the device application compared with the control teeth; at 7 days from the beginning of the treatment, only the IL 8 level in the experimental teeth being significantly higher compared with the control teeth. These results demonstrate that the levels of IL-1β and IL-8 in the gingival fluid increase with the dental movement taking place, due to a localized inflammatory process, as a response to mechanical stress. [ABSTRACT FROM AUTHOR]

The use of orthodontic appliances in the treatment of the various dento-maxillar anomalies most frequently presume the application of high intensity forces, non-physiological, which always will produce an inflammatory response localised around the tooth or the teeth subjected to displacement. The presence of an inflammatory process at this level will produce an increased synthesis of free radicals, secondary followed by the oxidative stress. In order to asses the level of the oxidative stress, a series of its markers are used, including the reactive species of oxygen and nitrogen, and the oxidation products in particular, such as lipid peroxides and oxidized proteins respectively. Thus, the objective of the present study is to determine and compare the levels of some oxidative stress markers (malondialdehyde, ceruloplasmine, hydrogen donors) in saliva of patients with orthodontic appliances, before and after the initiation of the treatment. The patients included in this study were 7 girls and 4 boys, with the average age of 9.9 years, in which orthodontic biomechanical appliances were applied, in the purpose of treatment of some dento-maxillar anomalies. Saliva has been collected before the initiation of the orthodontic treatment, at 1 hour, at 24 hours, and at 7 days from from the orthodontic appliance application. The variations in the concentrations of the saliva markers of the oxidative stress reached a maximum at 24 hours from the debut of the treatment for ceruloplasmine and malondialdehyde, and at one hour for the hydrogen donors respectively, while at 7 days from the device application the concentrations were close to the initial values. The health condition at the level of the oral cavity in the patients taken into study did not change during the research. These results demonstrate that the utilization of an orthodontic appliance changes the levels of the saliva markers of oxidative stress, but these variations, even statistically significant, do not determine the appearance of certain pathological processes at the level of the oral cavity. [ABSTRACT FROM AUTHOR]

The paper illustrates the way in which the dimensional control can be optimized via PC. It's about the dimensional measuring command as process, due to the PC, and also about the obtaining processing results, aided by PC. This aspect was solved by the graphical programming for the interfacing with the user of the aided by PC process. The graphical programming ensures not only the entire necessary information about each dimensional control cycle, but also the statistical monitorising of the measuring precision. [ABSTRACT FROM AUTHOR]

The ESKAPE group ( Enterococcus faecium , Staphylococcus aureus , Klebsiella Pneumoniae , Acinetobacter baumannii , Pseudomonas aeruginosa , Enterobacter spp.) is a group of bacteria very difficult to treat due to their high ability to acquire resistance to antibiotics and are the main cause of nosocomial infections worldwide, posing a threat to global public health. Nosocomial infections with MDR bacteria are found mainly in Intensive Care Units, due to the multitude of maneuvers and invasive medical devices used, the prolonged antibiotic treatments, the serious general condition of these critical patients, and the prolonged duration of hospitalization., Materials and Methods: During a period of one year, from January 2023 to December 2023, this cross-sectional study was conducted on patients diagnosed with sepsis admitted to the Intensive Care Unit of the Sibiu County Emergency Clinical Hospital. Samples taken were tracheal aspirate, catheter tip, pharyngeal exudate, wound secretion, urine culture, blood culture, and peritoneal fluid., Results: The most common bacteria isolated from patients admitted to our Intensive Care Unit was Klebsiella pneumoniae , followed by Acinetobacter baumanii and Pseudomonas aeruginosa . Gram-positive cocci ( Enterococcus faecium and Staphilococcus aureus ) were rarely isolated. Most of the bacteria isolated were MDR bacteria., Conclusions: The rise of antibiotic and antimicrobial resistance among strains in the nosocomial environment and especially in Intensive Care Units raises serious concerns about limited treatment options.

The worldwide increase of multidrug-resistant Gram-negative bacteria is a global threat. The emergence and global spread of Klebsiella pneumoniae carbapenemase- (KPC-) producing Klebsiella pneumoniae represent a particular concern. This pathogen has increased resistance and abilities to persist in human reservoirs, in hospital environments, on medical devices, and to generate biofilms. Mortality related to this microorganism is high among immunosuppressed oncological patients and those with multiple hospitalizations and an extended stay in intensive care. There is a severe threat posed by the ability of biofilms to grow and resist antibiotics. Various nanotechnology-based strategies have been studied and developed to prevent and combat serious health problems caused by biofilm infections. The aim of this review was to evaluate the implications of nanotechnology in eradicating biofilms with KPC-producing Klebsiella pneumoniae , one of the bacteria most frequently associated with nosocomial infections in intensive care units, including in our department, and to highlight studies presenting the potential applicability of TiO 2 nanocomposite materials in hospital practice. We also described the frequency of the presence of bacterial biofilms on medical surfaces, devices, and equipment. TiO 2 nanocomposite coatings are one of the best long-term options for antimicrobial efficacy due to their biocompatibility, stability, corrosion resistance, and low cost; they find their applicability in hospital practice due to their critical antimicrobial role for surfaces and orthopedic and dental implants. The International Agency for Research on Cancer has recently classified titanium dioxide nanoparticles (TiO 2 NPs) as possibly carcinogenic. Currently, there is an interest in the ecological, non-toxic synthesis of TiO 2 nanoparticles via biological methods. Biogenic, non-toxic nanoparticles have remarkable properties due to their biocompatibility, stability, and size. Few studies have mentioned the use of nanoparticle-coated surfaces as antibiofilm agents. A literature review was performed to identify publications related to KPC-producing Klebsiella pneumoniae biofilms and antimicrobial TiO 2 photocatalytic nanocomposite coatings. There are few reviews on the antibacterial and antibiofilm applications of TiO 2 photocatalytic nanocomposite coatings. TiO 2 nanoparticles demonstrated marked antibiofilm activity, but being nano in size, these nanoparticles can penetrate cell membranes and may initiate cellular toxicity and genotoxicity. Biogenic TiO 2 nanoparticles obtained via green, ecological technology have less applicability but are actively investigated.

Aim: Clostridium difficile infection is a cause of increased morbidity and mortality in hospitals, particularly in patients with cancer pathology. There are several factors favouring the development of Clostridium difficile infection among cancer patients, including age, exposure to antibiotic and proton pump inhibitors therapy, and chemotherapy. This study was conducted to observe the prevalence of Clostridium difficile infection after the reversal of ileostomy loop for rectal cancer surgery, which were initially operated either open or laparoscopic., Method: A retrospective study was performed on patients who were operated in a single surgical team for rectal cancer who benefited of a diverted loop ileostomy over a 4-year period. Results: 23 patients were documented with Clostridium difficile infection out of a total of 63. All 23 patients underwent ileostomy closure later than 3 months after primary surgery, and postoperatively received antibiotic therapy associated with proton pump inhibitors in the first 24 hours. Conclusions: Closure of ileostomy later than 3 months after primary surgery, combined with chemotherapy, antibiotic therapy and proton pump inhibitors, increases the risk of developing Clostridium difficile infection., (Celsius.)

Background: Teledermatology utilizes photoimaging and background information to allow dermatologists to remotely provide a diagnosis to practitioners. ConsultDerm is an asynchronous, web-based teledermatology software that allows practitioners to submit their electronic referrals for assessment by board-certified dermatologists., Objective: Our study aimed to retrospectively analyze teledermatology's utilization in Canada by using the teledermatology platform ConsultDerm., Methods: After implementing inclusion criteria, 1000 patients were selected, and relevant demographic and clinical information were extracted for data analysis. In addition, an online survey with pre-formulated questions was distributed to 7 dermatologists currently using the ConsultDerm platform to determine their experience in utilizing teledermatology., Results: Of the 1000 patients, 66.5% had not received treatment prior to their teledermatology referral, and on average, patients experienced symptoms for 489.5 days prior to their referral. Diagnoses made were categorized by conditions, most common being dermatitis (37.1%), followed by acneiform conditions (10.6%), benign lesions/neoplasms (12.1%), infections (9.4%), and dyspigmentation (3.1%). Most consults originated from small population centers, and the referring practitioners were predominantly family physicians. Dermatologists utilizing the platform expressed ease of use, however, areas of improvement were identified such as increasing the quality of imaging and more detailed patient history., Conclusion: Through our analysis of 1000 cases, we identified how a teledermatology consultation could be used to assess a wide variety of cutaneous conditions, improving access for patients who may face barriers to seeing a dermatologist.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions., Objectives: To learn about the clinical characteristics of patients with SJS/TEN including treatments provided, outcomes, and mortality., Methods: We conducted a retrospective chart review of patients who were hospitalized with the diagnosis of SJS/TEN at the Ross Tilley Burn Center between the years 1999 and 2015., Results: A total of 43 patients were identified with a mean age of 54 ± 19 (58, 18-85). The most common offending medications were allopurinol and carbamazepine. The overall mortality rate in our study is 21% with the most common causes of death being multiorgan failure and sepsis. The majority of our patients had oral (84%), ocular (79%), and genital (60%) involvement during hospitalization. Our data revealed that combination treatment involving oral corticosteroids with intravenous immunoglobulin (IVIG) had the highest mortality rate in our study since 55% (6/11) of patients who were treated in this manner passed away compared to 11% (2/18) of patients passing away who were treated with solely IVIG and 33% (1/3) who were treated with only supportive care. Our study also demonstrates the addition of etanercept and cyclosporine treatment in the second time period we studied: 2008-2015 versus the earlier time period of 1999-2007. None of the patients in our study who were treated with therapies including cyclosporine and/or etanercept passed away., Conclusions: Our study sheds light on a possible beneficial role of cyclosporine and etanercept for the treatment of SJS and TEN and reinforces the necessity of a multidisciplinary care team for patients.

Gamma and theta oscillations have been functionally associated with cognitive processes, such as learning and memory. Synaptic conductances play an important role in the generation of intrinsic network rhythmicity, but few studies have examined the effects of voltage-gated ion channels (VGICs) on these rhythms. In this report, we have used a pyramidal-interneuron-gamma (PING) network consisting of excitatory pyramidal cells and two types of inhibitory interneurons. We have constructed a conductance-based neural network incorporating a persistent sodium current ( I NaP ), a delayed rectifier potassium current ( I KDR ), a inactivating potassium current ( I A ) and a hyperpolarization-activated current ( I H ). We have investigated the effects of several conductances on network theta and gamma frequency oscillations. Variation of all conductances of interest changed network rhythmicity. Theta power was altered by all conductances tested. Gamma rhythmogenesis was dependent on I A and I H . The I KDR currents in excitatory pyramidal cells as well as both types of inhibitory interneurons were essential for theta rhythmogenesis and altered gamma rhythm properties. Increasing I NaP suppressed both gamma and theta rhythms. Addition of noise did not alter these patterns. Our findings suggest that VGICs strongly affect brain network rhythms. Further investigations in vivo will be of great interest, including potential effects on neural function and cognition., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Olteanu, Habibollahi and French.)

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated adverse reactions characterized by widespread erythema, epidermal necrosis, and detachment of skin and mucosa. Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on SJS/TEN as an uncommon but high burden disease will be necessary to improve efforts in prevention, early diagnosis and improved acute and long-term management. SJS/TEN 2019: From Science to Translation was a 1.5-day scientific program held April 26-27, 2019, in Vancouver, Canada. The meeting successfully engaged clinicians, researchers, and patients and conducted many productive discussions on research and patient care needs., (Crown Copyright © 2020. Published by Elsevier B.V. All rights reserved.)

Background and Aims: The purpose of the study is to evaluate through a FEM (Finite Element Method) the effects of the rotation movement upon a complex structure (enamel- pulp -alveolar bone, PDL), for external load., Method: The progressive action of a fixed orthodontic device on three teeth: first molar, first and second premolar is modeled and simulated with the components placed on the buccal and palatal surfaces of the tooth. For the reproduction of a situation similar to the real one, the loading of the model was performed through a nodal force applied at a height of the crown, of various amplitudes, F = 1 N; 2, 3 and 4 N. The values of stress are: maximum stress of the whole structure and the shearing effect for the pulp., Results: The characteristics of the material are Young's E modulus and Poisson's ratio of the components of the modeled structure. The most stressed elements of the structure are the pulp and the ligament, revealed by von Mises stress. The elements of the structure are mainly stressed in fiber compression in the direction of the moment's action given by the orthodontic forces and in fiber stretching in the opposite direction. Out of the orthodontic movements: translation, tipping, intrusion-extrusion, rotation is the most dangerous., Conclusions: The accumulated stress effect in the pulp becomes dangerous. The orthodontic movements given by dental force values higher than 1.5-2N are to be avoided.

Sarcoidosis is an idiopathic disease, characterized by non-caseating granulomas in multiple organs/tissues. Cutaneous involvement occurs in approximately one-quarter of patients with a wide variety of presenting morphologies. This case report describes a case of photodistributed sarcoidosis, a rare cutaneous variant, with systemic involvement. A 42-year-old man presented with a history of a pruritic, rash with photoexacerbated annular plaques along with arthralgias and bone pain. Compared to previous reports of photodistributed sarcoidosis, our case presented with annular plaques rather than papules, and there was no prior exposure to ionizing radiation. He was treated successfully with prednisone and hydroxychloroquine. It is important to include sarcoidosis in the differential of photodistributed dermatoses., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Few studies have reported the physical complications among Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) survivors., Objective: The aim of this study was to comprehensively characterize the physical complications among SJS/TEN survivors and to learn about patients' perspectives of surviving SJS/TEN., Methods: SJS/TEN survivors older than 18 years of age were assessed by different methods: a medical interview; a questionnaire assessing patients' perspectives; thorough skin, oral mucous membrane, and ophthalmic examinations; and a retrospective assessment of medical records., Results: Our cohort consisted of 17 patients with a mean time of 51.6 ± 74.7 months (median 9, range 1-228) following SJS/TEN. The most common physical complications identified in the medical examination were post-inflammatory skin changes (77%), cutaneous scars (46%), dry eyes (44%), symblepharon, and chronic ocular surface inflammation (33% each). Novel physical sequelae included chronic fatigue (76%) and pruritus (53%). We also found a novel association between the number of mucous membranes affected in the acute phase of SJS/TEN and hair loss during the 6 months following hospital discharge; hair loss was reported in 88% of the group of patients who had three or more mucous membranes affected versus 29% of patients who had less than three mucous membranes involved (p = 0.0406). Following hospital discharge due to SJS/TEN, 59% of patients were followed by a dermatologist, although 88% had dermatological complications; 6% were followed by an ophthalmologist, even though 67% had ophthalmological complications; and 6% of female survivors were followed by a gynecologist, even though 27% had gynecological complications., Conclusion: Survivors of SJS/TEN suffer from severe physical complications impacting their health and lives that are mostly under recognized and not sufficiently treated by medical professionals.

Background: Websites for residency and fellowship programs serve as effective educational and recruitment tools., Objective: To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development., Methods: A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive 'Google' search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P<0.05 was considered to be statistically significant)., Results: A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed 'eligibility criteria' (87%) and 'general information' (87%). 'Evaluation criteria' were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on 'extremity' versus 'breast' (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process., Conclusion: Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.

Background: Enucleation (eye removal) is often the only curative treatment for the childhood eye cancer retinoblastoma, yet parental refusal of enucleation commonly contributes to treatment delay and poor survival globally., Methods: Physicians who treat retinoblastoma were surveyed to glean underlying reasons for treatment refusal., Results: Refusal rates were higher when less time was spent with parents explaining retinoblastoma/enucleation, and where fewer support services were available. Reasons for refusal included parental belief in alternative treatments, culture, and social stigma., Conclusions: We suggest strategies to increase parental compliance with enucleation and save the lives of children with retinoblastoma.

Objective: The purpose of this study is to highlight the high incidence of gallstones and the etiology in young people, as well as the fact that the onset is associated with complications: i.e. acute pancreatitis, jaundice., Material and Methods: This retrospective study was conducted between January 2007 and February 2012 on patients admitted to the two surgical wards of Pitesti District Hospital and was based on the analysis of observation charts and theatre records. A total of 1905 cholecystectomies were performed, 1023 laparoscopic and 882 classic, respectively., Results: A total of 36 patients aged between 16 and 25 years were included in the study. Laparoscopic cholecystectomy was performed in 34 patients, only two patients being operated by the classical open approach. 6 patients developed postoperative jaundice, which resolved under medical treatment in 3 patients within 3-5 days. The remaining 3 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) 4-5 days postoperatively., Conclusions: The most important risk factors for gallstones are: age, female gender, pregnancy and obesity. Common complications of gallstones in young people are: duct stones and acute pancreatitis., (RevistaChirurgia.)