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The COVID-19 pandemic has altered and reshaped the delivery of oral and maxillofacial surgery (OMS) over the past few months. As the USA gradually lifts restrictions and re-opens, surgeons must adjust accordingly. Therefore, the OMS Resurgence Conference: Safely Resuming Practice with a New Normal was organized for 11 May 2020 to gather and disseminate expert opinions and recommendations for OMSs to thoughtfully resume work with efficiency and safety. This manuscript offers a summary of the highlights from the conference discussion. [ABSTRACT FROM AUTHOR]

The present study aims to identify if immunosuppression is a risk factor for the development of peri-implantitis. A retrospective cohort study design was conducted on patients presenting to the Philadelphia Veterans Affairs (VA) Medical Center for dental implant placement from 2006 to 2013. Medical encounter notes within 3 months of implant placement were used to collect information about patients' health status, including evaluations of immune system function. Implant status was assessed using dental encounter notes and radiographs from follow-up appointments at 1, 3, 5, and 10 years. Peri-implantitis was defined as radiographic evidence of change in crestal bone level, clinical evidence of bleeding on probing, with or without suppuration.1 Electronic medical records of 884 implants were retrospectively analyzed. Descriptive statistics were calculated using the SAS System (SAS Institute Version 9.4, 2002-2012, Cary, NC). The primary predictor variable was immunosuppression. The primary outcome variable was the presence of peri-implantitis. Other study variables assessed included graft at the time of implant placement, diabetes, smoking, gender, and age over 60. Descriptive, univariate, and multivariate regression analyses were performed to measure the association between predictive variables and development of peri-implantitis. Of the 884 implants placed, 205 (23.1%) developed peri-implantitis. Following a multivariate analysis that controlled for diabetes, smoking, gender, and age over 60, immunosuppression was shown to be significantly associated with an increased risk in the presence of peri-implantitis (P =.0071) when compared to implants placed in immunocompetent subjects. The data from this study show that implants placed in immunosuppressed patients were 29.78% more likely to develop peri-implantitis compared to implants placed in immunocompetent patients (OR = 2.229, 95% CI 1.243-3.996). To the best of the authors' knowledge, no existing literature has demonstrated this significant risk relationship. Following surgical implant placement, adequate function of the immune system's inflammatory response is imperative to target infections and orchestrates wound healing to allow for successful osseointegration of implants. Few studies, however, have directly investigated this nexus at a mechanistic level. In vivo studies in rabbits have indicated that titanium implant placement may up-regulate the immune system's type 2 inflammatory response to inhibit bone resorption markers and promote healing.2 Therefore, in conjunction with the authors' results, immunosuppression could play a significant role in increasing risk of peri-implantitis. Analysis of implants placed at the Philadelphia VA Medical Center revealed an important association between immunosuppression and the development of peri-implantitis. This study shows that immunosuppression may play a role in increasing the development of peri-implantitis. Along with need for further exploration regarding the pathophysiology of this relationship, additional observational and randomized controlled studies are necessary to validate the authors' findings. As implant restoration of edentulous areas is becoming the new standard of care, identification and understanding of associated risks factors are critical to ensure successful implant outcomes. [ABSTRACT FROM AUTHOR]

While opioid prescription behavior among oral and maxillofacial surgeons (OMSs) has become increasingly responsible in the past few years, the opioid misuse crisis remains a major public health challenge. There are many differences in the access to and delivery of oral and maxillofacial services in urban settings compared to rural settings. In other areas of medicine, such as primary care, opioids are more often prescribed in rural settings.1,2 This study aimed to compare opioid analgesic prescription patterns among OMSs practicing in urban and rural settings in an effort to identify avenues to further promote responsible opioid prescribing. This cross-sectional study used publicly available Medicare Provider Utilization and Payment Data from 2014 to 2018, focusing on providers labeled as OMS. Rural-Urban Commuting Area Codes (RUCA) were used to categorize each OMS as urban or rural. The outcome variables included Total Claims of Opioids (Including Refills), Mean Opioid Prescriptions Per Beneficiary, and Number of Days Supply of Opioids Per Claim. Descriptive statistics were summarized, and Wilcoxon rank-sum tests were employed to compare continuous variable means with statistical significance at P-value <.05. The study sample, from 2014-2018, consisted of mostly urban and male OMSs (Table 1). The mean number of beneficiaries per OMS varied widely, and the mean age of beneficiaries was around 70 years. The mean hierarchical condition category (HCC), used as a proxy for patient complexity, was similar between rural versus urban OMSs across all years. The mean opioid claims per provider was higher among rural OMSs across all years, with large standard deviations among both rural and urban OMSs (Table 2). However, there were no statistically significant differences in the mean opioid prescriptions per beneficiary (about 1.1-1.2). While in some years there were statistically significant differences between urban and rural OMSs in the number of days' supply per claim, the magnitude of difference was small (all periods had about 3-4 days). Finally, there were no documented instances of any long-term opioid prescriptions by any OMSs in the dataset. While rural OMSs prescribed a higher mean volume of opioid analgesics than their urban counterparts, there were no differences in mean amount of opioids prescriptions written per beneficiary. These results suggest similar opioid prescription behaviors among the majority of OMSs practicing in both rural and urban settings. However, the large standard deviation in the mean opioid claims per provider affirms previous work that have found extreme cases of opioid prescription volume among a subset of Medicare OMSs.3 Limitations of this study includes the relatively small number of rural OMSs in the dataset and its limited generalizability to prescription behaviors toward the non-elderly population. [ABSTRACT FROM AUTHOR]

A general approach for the attitude control of directional drilling tools for the oil and gas industry is proposed. The attitude is represented by a unit vector, thus the non-linearities introduced by Euler angle representations are avoided. Three control laws are proposed, and their stability is proven. Their behaviour is tested by numerical simulation. The merits of the laws from an engineering perspective are highlighted, and some details for the implementation of the laws on directional drilling tools are provided. [ABSTRACT FROM AUTHOR]

Ischemia-reperfusion injury is a phenomenon whereby cellular damage in a hypoxic organ is accentuated following the restoration of oxygen delivery. Wistar rats of either sex (250-300 g) were treated for 15 days with alcoholic extract of Emblica officinalis fruits (250-500mg/kg) prior to ischemic reperfusion. After 15 days ischemia was produced by clamping the right common carotid artery for 25 min and reperfusion for 40 min by unclamping. Brain was dissected out to prepare a homogenate to measure the level of malondialdehyde, superoxide dismutase, catalase, vitamin C and protein estimation. Animals subjected to ischemic reperfusion without any treatment were included as model control and animals treated with vitamin E were included as a standard. Animals subjected to ischemic reperfusion without any treatment showed higher level of oxidative enzymes and lower level of protective enzymes as compared with the animals treated with alcoholic extract of amla fruits. In histopathology, protection against the injury in the animals treated with alcoholic extract of amla fruits was noted. [ABSTRACT FROM AUTHOR]

This study was undertaken to assess the effects of atorvastatin on cognition and higher mental functions. In this before and after comparison study with controls, group one included 55 subjects aged ≥40 years requiring statins for cardiovascular indications who were started on atorvastatin (10 mg/day). Group two assigned to receive placebo were men and women chosen from the same geographical area and matched for age, sex, education and presence of hypertension and diabetes mellitus. Assessment was done with the Mini-Mental State Examination, Digit Span, Picture Test (average and delayed), Trail Making Test, Controlled Oral Word Association Test, Digit Symbol Substitution Test and Auditory Vigilance and Digit Vigilance Test at baseline and after 6 months. Changes between baseline and 6 months in the above parameters of mental function were compared using suitable statistical tests in the atorvastatin and placebo groups. To limit experiment-wise error, performance scores were grouped into five cognitive domains, which were labeled as attention, psychomotor speed, mental flexibility, working memory and memory retrieval. Summary effect sizes were estimated as z-scores. Both subjects on atorvastatin and placebo showed improvement in the majority of scales consistent with a learning effect on test performance. However, subjects treated with atorvastatin scored significantly over the placebo group in all domains, i.e. tests of attention [ z-score=0.54, 95% confidence interval (CI): 0.38–0.64, p=0.001], psychomotor speed ( z-score=0.28, 95% CI: O.09–0.47, p<0.001), mental flexibility ( z-score=0.27, 95% CI: 0.22–0.32, p=0.01), working memory ( z-score=1.22, 95% CI: 0.93–1.50, p<0.001) and memory retrieval ( z-score=0.59, 95% CI: 0.36–0.82, p<0.05). The present study concludes that there are significant beneficial effects of atorvastatin in a dose of 10 mg/day for a period of 6 months on higher functions as measured by the above standard neurocognitive tests. [ABSTRACT FROM AUTHOR]

Objectives: To determine the efficacy of intravenous iron sucrose and oral iron in anaemic postpartum women, presenting at Institute of Kidney Disease and Research Centre. Method: Descriptive case series. The study was carried out in the department of Obstetrics and Gynaecology at Institute of Kidney Disease and Research Centre over a period of six months from 02- 02-2010 to 02-08-2010. 50 cases with proven iron deficiency with Hb ≤7gm% were included in the study. Total iron deficit was calculated using a standard formula. Target haemoglobin was 12 gm %. Iron sucrose was administered by intravenous infusion. Haemoglobin was repeated 1, 2, 3, and 4 weeks after the last dose of intravenous iron sucrose. Results: On inclusion, the 2 groups were comparable in terms of both anthropometric and biologic data Distribution of cases by economic status showed, 21 patients (42.0%) belonged to lower class, 20 patients (40%) belonged to middle class and 09 patients (18%) were of upper class).Target hemoglobin levels were achieved in 4 weeks’ time in 20 (80%) patients in iron sucrose group as compared to 10 (40%) of patients in oral iron group .There was significant improvement in the various hematological parameters in iv sucrose group as compared to patients in oral iron group. There were no significant allergic reactions in IV sucrose group. Conclusion: This study has shown a significant improvement in the iron sucrose group. Iron sucrose is safe and well tolerated.

Objective: To compare intravenous iron sucrose with oral iron in treatment of severe iron deficiency anaemia in pregnant women presenting at Institute of Kidney Disease and Research Centre. The study was carried out in the department of Obstetrics and Gynaecology at Institute of Kidney Disease and Research Centre over a period of six months from 02-02-2010 TO 2-08-2010. Methodology: 50 cases with proven iron deficiency with Hb ≤7 gm/dl were included in the study. Total iron deficit was calculated using a standard formula. Target haemoglobin was 11 gm %. Iron sucrose was administered by intravenous infusion. Haemoglobin was repeated 1, 2, 3, and 4 weeks after the last dose of Intravenous Iron sucrose. Results: Anthropometric and biologic data for mothers in i.v. sucrose and oral iron groups was similar. Distribution of cases by economic status showed, 21 patients (42.0%) belonged to lower class, 20 patients (40%) belonged to middle class and 09 patients (18%) were of upper class.) Target haemoglobin levels were achieved in 4 weeks’ time in 19 (76%) patients in iron sucrose group as compared to 08 (32%) of patients in oral iron group. There was significant improvement in the various haematological parameters in iv sucrose group as compared to patients in oral iron group. There were no significant allergic reactions in iv sucrose group. Conclusion: This study has shown a significant improvement in anaemia in the iron sucrose group. Patients achieved the target of 11 gm %. Intravenous iron therapy is safe, convenient and more effective than oral iron therapy in pregnancy and is well tolerated.

Bacterial DNA gyrase and topoisomerase IV inhibition has emerged as a promising strategy for the cure of infections caused by antibiotic-resistant bacteria. The Novel Bacterial Topoisomerase Inhibitors (NBTIs) bind to a different site from that of the quinolones with novel mechanism of action. This evades the existing target-mediated bacterial resistance associated with quinolones. This article presents our efforts to identify in vitro potent and broad-spectrum antibacterial agent 4l., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Competing Interests: Disclosure None of the authors reported any disclosures.

Odontogenic cysts impact the adjacent dentition and maxillary sinus. A combined transnasal, transoral approach for removal offers reduced recurrence rates and favorable sinonasal outcomes compared with historic transoral-only approaches., (© 2024 The Authors. The Laryngoscope published by Wiley Periodicals LLC on behalf of The American Laryngological, Rhinological and Otological Society, Inc.)

Background: Active surveillance (AS) is standard care for most men with low-risk prostate cancer (PC); yet, many men on AS eventually undergo curative therapy. Interventions to lower the risk of cancer progression and fear of recurrence among men on AS for PC are needed., Objective: To determine the effect of aerobic exercise on cardiorespiratory fitness, body size, and quality of life (QOL) among men on AS for PC., Design, Setting, and Participants: We conducted a 1:1 randomized controlled trial among 51 men with low-risk PC who elected AS. Participants were enrolled at the University of California, San Francisco., Intervention: The 16-wk intervention included a home-based walking program with a nonlinear exercise prescription tailored to baseline fitness level, heart rate monitor, and weekly phone call with an exercise physiologist. Controls received printed materials., Outcome Measurements and Statistical Analysis: Cardiorespiratory fitness was measured using VO 2 peak; secondary outcomes included change in body size, anxiety, and QOL. Analyses were based on intention to treat., Results and Limitations: Between 2016 and 2021, we randomized 51 men to intervention (n = 26) or control (n = 25). Follow-up was 88% (45/51), 85% (22/26) in the intervention and 92% (23/25) in the control group. At 16 wk, the intervention group had a higher mean VO 2 peak than the control group (31.9 ± 4.7 vs 27.2 ± 4.8 ml/kg/min; group × time effect p value: <0.001). Additionally, the intervention group reported less fear of PC recurrence and urinary obstruction/irritation, while controls reported more of these two QOL measures, from 0 to 16 wk (p = 0.04 and 0.03, respectively). Two participants discontinued the intervention, including one due to knee pain related to the study., Conclusions: A home-based walking program improved VO 2 peak and reduced urinary obstruction/irritation and fear of recurrence among men on AS for PC., Patient Summary: Moderate to vigorous aerobic exercise improves fitness and quality of life among men on active surveillance for prostate cancer., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Understanding the genetic adaptations that occurred as humans migrated out of Africa to higher latitudes helps explain on a population-wide level how UV radiation (UVR) exposure will have varying consequences and benefits in patients of different skin pigmentations. It has been hypothesized that the need for efficient vitamin D synthesis was the primary driver for the skin-lightening process that evolutionarily occurred as humans migrated to higher latitudes. This review analyzes the level of support for the hypothesis that skin lightening occurred to enable adequate vitamin D synthesis in populations that migrated to areas with less UVR. Our literature search supported the hypothesis that through natural selection and intricate genetic adaptations, humans who migrated to areas with lower levels of UVR underwent a skin-lightening process to avoid the consequences of vitamin D deficiency. Our review includes an analysis of migration patterns out of Africa and how these affected pigmentation genes that are found in certain ethnic populations can be used to better understand this critical adaptation process when counseling patients on the need for sun protection.

Objective: Maxillary sinusitis can be a sequela of medication-related osteonecrosis of the jaw (MRONJ). This study aims to characterize the microbiome of maxillary MRONJ with concurrent maxillary sinusitis and radiographic maxillary sinus opacification to determine if there is a relationship between the microbiome of MRONJ and sinus disease., Study Design: This retrospective case series was conducted using electronic health records from the University of Pennsylvania and affiliated hospitals. The target population was surgically managed maxillary MRONJ patients. The primary predictor variables were tissue culture results. The primary outcomes were maxillary sinusitis or maxillary sinus opacification. Statistical analysis was performed using chi-squared tests at the 95% confidence interval., Results: Thirty-nine subjects were selected: 25 had sinus opacification and 11 had sinusitis. Resident bacteria were present in 90% of subjects, nonresident bacteria in 74%, and opportunistic organisms in 15%. There were significantly more subjects with chronic sinusitis microbes (79%) than without. There were significantly more gram-positive anaerobes, specifically Propionibacterium, as well as the gram-negative facultative anaerobe, Capnocytophaga, in subjects with concurrent sinusitis., Conclusions: Maxillary MRONJ with concurrent maxillary sinusitis may be associated with gram-positive anaerobic species, Propionibacterium, and Capnocytophaga colonization. Maxillary MRONJ patients may benefit from sinus evaluation and concurrent surgical intervention., (Copyright © 2024. Published by Elsevier Inc.)

Aims: To outline key factors that contribute to oral health issues of refugees and asylum seekers and provide management strategies for dental providers to teach desensitization and fear reduction for this special population., Methods and Results: We researched published literature in the PubMed database and incorporated lessons gained from treating refugee and asylee patients at a Vulnerable Populations Clinic (VPC) at an urban academic dental school. Refugees and asylees are at high risk for oral conditions due to a tendency to not seek routine dental treatment, psychological stressors, and various systemic factors. Oral health providers can teach patients desensitization and fear reduction by working to gain patients' trust by having effective communication and prioritizing comfort in the dental operatory. Providers should also utilize translation, psychological, and/or multicultural support services during their management of care., Conclusion: By having a stronger understanding of the key causes of oral health issues among refugees and asylees in the United States, dental providers can better approach managing care for this vulnerable patient population. The concepts of teaching desensitization and fear reduction utilized for this special population can be applied to managing care for the wider special needs patient community., (© 2022 Special Care Dentistry Association and Wiley Periodicals LLC.)

Background: Culture of bronchoalveolar lavage (BAL) specimens takes time to report. We tested whether a molecular diagnostic test could accelerate donor lung assessment and treatment., Methods: We compared BioFire Film Array Pneumonia Panel (BFPP) with standard of care (SOC) tests on lung allograft samples at three time points: (1) donor BAL at organ recovery, (2) donor bronchial tissue and airway swab at implantation, and (3) first recipient BAL following lung implantation. Primary outcomes were the difference in time to result (Wilcoxon signed-ranked tests) and the agreement in results between BFPP and SOC assays (Gwet's agreement coefficient)., Results: We enrolled 50 subjects. In donor lung BAL specimens, BFPP detected 52 infections (14 out of 26 pathogens in the panel). Viral and bacterial BFPP results were reported 2.4 h (interquartile range, IQR 2.0-6.4) following BAL versus 4.6 h (IQR 1.9-6.0, p = 0.625) for OPO BAL viral SOC results and 66 h (IQR 47-87, p < .0001) for OPO BAL bacterial SOC results. Although there was high overall agreement of results between BAL-BFPP versus OPO BAL-SOC tests (Gwet's AC p < .001 for all), the level of agreement differed among 26 pathogens designed in BFPP and differed by types of specimens. BFPP could not detect many infections identified by SOC assays., Conclusions: BFPP decreased time to detection of lung pathogens among donated lungs, but it cannot replace SOC tests due to the limited number of pathogens in the panel., (© 2023 The Authors. Transplant Infectious Disease published by Wiley Periodicals LLC.)

The scenario presented is of a patient in the dental chair who had history of myocardial infarction and history of stent placed in the left anterior descending coronary artery who now presents with acute chest pain, chest tightness, and extreme dizziness. Confirming cardiopulmonary arrest and beginning basic life support are the first steps in the management followed by defibrillation, advanced cardiac life support, post-resuscitation care, and long-term management., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Dentists should be equipped to treat any allergic reaction in a dental office and in this scenario, anaphylaxis is noted after administration of a penicillin derivative given before a dental procedure. Identification of signs and symptoms related to anaphylaxis is vital and appropriate management of the patient is the key. The dental management of the scenario goes into the diagnosis and management of anaphylaxis in a dental office., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Oral and maxillofacial surgery (OMS) residencies commonly affiliate with Veterans Affairs Medical Centers (VAMC) to extend care for veterans. This study quantifies the surgical experience of residents at the Corporal Michael J. Crescenz (CMC) VAMC in Philadelphia, Pennsylvania and determines the number of programs affiliated with VA Medical Centers, to enumerate the educational benefits and improve veteran healthcare., Methods: The dental project manager logs from 2012 through 2021 of the CMC VAMC operating room were analyzed, and cases were categorized into 12 groups. The implant cases from 2012 through 2021 were quantified. Program affiliations were determined using a VA Office of Academic Affiliation report., Results: There were 1359 procedures (760 cases) performed. Dentoalveolar (n = 967) was the most common category, and extractions (n = 384) were the most common procedure. The least cases and procedures were performed in 2012 (n = 14; n = 23). The most cases were performed in 2019 (n = 137), and the most procedures were performed in 2019 and 2021 (n = 255). There were 3133 implants placed. There are 40 OMS programs affiliated with VA Medical Centers; more dual degree (n = 24) than single degree (n = 16) programs having an affiliation., Conclusion: The CMC VAMC offers robust dentoalveolar experience and is increasing in surgical volume, representing the expected needs of an aging veteran population. An increasing budget and millions of eligible veterans indicates VA medical centers nationally will continue to provide valuable surgical experiences., (© 2023 American Dental Education Association.)

Dentists should be trained to treat any allergic reaction in a dental office, and in this scenario, allergic reaction to latex-based product (rubber dam) is illustrated. Identification of signs and symptoms related to latex allergies is vital, and all dentists should be trained in the appropriate management of such a patient. The dental management of the scenario describes details of the diagnosis and management of latex-related allergies in a dental office for both adults and children., (Copyright © 2023 Elsevier Inc. All rights reserved.)

All dentists should be trained in the diagnosis and management of seizures in a dental chair. Although epilepsy is a common etiological factor, there are other medical situations whereby seizures are manifested. Once a seizure is suspected and other causes of altered consciousness or involuntary motor movements are ruled out, proper management should commence immediately. The first step in management is to immediately remove/stop all provocative factors, like bright flashing lights, drill sounds, and such. Benzodiazepines remain as the first-line treatment for patients with continued seizures before activating emergency medical services., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Dentists should be equipped to treat an allergic reaction in a dental office, and in this scenario, the potential allergic reaction is noted after administration of a common local anesthetic lidocaine with epinephrine. The allergic reaction quickly escalates to a full-blown anaphylaxis, and the management of such an episode is detailed in this article., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Although dental treatment in a patient with well-controlled type 2 diabetes mellitus is uncomplicated, hypoglycemia is one of the most dreaded complications among diabetics and remains as one of the leading causes of endocrine medical emergencies. Identification and prompt treatment is important to all dental practitioners. This scenario goes into the diagnosis and management of medication-induced hypoglycemia., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Patients with extreme dental anxiety and dental phobia are candidates for syncope attacks in a dental chair. Early recognition and management of these episodes is important. Vasovagal syncope is often preceded by prodromal signs and symptoms like facial pallor, diaphoresis, fainting, dizziness, nausea, or vomiting. If any element of the patient's airway, breathing, or cardiovascular system is no longer intact, the provider should commence emergency basic life support protocols and notify emergency medical services immediately., (Copyright © 2023 Elsevier Inc. All rights reserved.)