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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants have instigated the global COVID-19 pandemic, which unfolded in waves over nearly three years since its emergence in 2019. Variances in host immune responses have resulted in a spectrum of symptoms ranging from asymptomatic to mild, moderate, severe pneumonia-like, or critical conditions. For many individuals, symptomatic conditions exacerbated and posed life-threatening risks, particularly when co-morbidities such as diabetes mellitus, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), hypertension, malignancies, and HIV were present. This study was aimed to ascertain the co-morbidity trends across the two major waves of COVID-19. Method: In India, COVID-19 patients from the first wave (April 1, 2020 to January 31, 2021) and the second wave (March 1, 2021 to October 1, 2021) were categorized into asymptomatic, moderate, severe, and critical groups, with 100 patients in each category. These patient groups were further subdivided based on co-morbidities and subjected to data analysis. Results: Diabetes mellitus, hypertension, and lung complications were identified as common co-morbidities significantly impacting the quality of life for COVID-19 patients. Conclusions: Our data analysis has highlighted the influence of co-morbidities or multi-morbidities in exacerbating severe and critical conditions during both waves 1 and 2 of COVID-19 infections.

Introduction: December 2019, witnessed the emergence of a novel coronavirus in human population. Later named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has since spread across the globe and results into coronavirus disease 2019 (COVID-19) pandemic. Objective: The objective of this study was to evaluate COVID-19 infection positivity rate, its age and gender wise prevalence and to compare the results of rapid antigen detection test with gold standard real time RT-PCR for early detection of SARS-CoV-2 virus. Methods: An observational study was conducted in the Department of Microbiology and Molecular Biology of Krishna Institute of Medical Sciences, Secunderabad, Telangana. Results: A total of 208 patients’ specimens (nasopharyngeal swab) were compared within a period of one and half month. Infection positivity rate was observed as 26.92% (n=56). Our study revealed that among all 56 COVID-19 positive patients, 60.71% (n=34) were symptomatic whereas 39.2% (n=22) were asymptomatic. Conclusion: We conclude that after comparing with real time RT-PCR, antigen detection assay is not as sensitive as molecular test especially during the early stages of infection but this has potential to become an important tool for mass screening for COVID-19 and can be considered as fast and economic diagnostic tools in the remote areas where the laboratory facilities for molecular tests are not accessible.

In early December 2019, an outbreak of novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) as it is now called, occurred in Wuhan City, Hubei Province, China. On January 30, 2020 the World Health Organization declared the outbreak as a Public Health Emergency of International Concern. Vaccines to prevent human coronavirus infections are not yet available. Coronavirus disease 2019 (COVID-19) spreads primarily when people are in close contact with small droplets produced by an infected person, identified as “super spreaders”. COVID-19 can be fatal among high-risk groups patients >60 yr. The envelope spike “S” protein receptor binding domain of SARS-CoV-2 use host receptor angiotensin-converting enzyme 2 (ACE2) to enter the cells of airway epithelium and alveolar type 2 (AT2) pneumocytes, and pulmonary cells. The most common clinical features are fever (80-90%), cough (60-80%) and breathlessness (18-46%). The other symptoms include myalgia, sore throat, loss of taste and smell, headache, nausea, vomiting and diarrhoea. Infection control practices to be followed stringently by Health Care Workers (HCW). Standard precautions to be maintained. Specimen to be packed in triple container packing. Cold temperature to be maintained during transport and storage. Laboratory tests of COVID-19 are broadly categorized into two methods: (1) Nucleic acid based assay: RT-PCR, TrueNAT, CBNAAT & (2) Immunoassay: Can be broadly divided into 2 types: Antigen based assay: Rapid antigen test, Antibody based assay: enzyme-linked immunosorbent assay (ELISA).

The world is in dire need of safe, effective coronavirus disease 2019 (COVID-19) vaccine strategies. Since its emergence in November 2019, it has spread to 188 countries and 25 territories around the globe, despite elaborate efforts by World Health Organization (WHO) and governments to contain the infection, primarily owing to the highly infectious nature of this virus. Present article reviews various aspects in process of vaccine designing, vaccine platforms and current efforts and progress of COVID-19 vaccine candidates. The founding of the COVID-19 vaccines global access (COVAX) facility by Gavi, the coalition for epidemic preparedness innovations (CEPI) and the WHO is an attempt to garner resources and unite higher- and lower-income countries for the coordinated, rapid, transparent and equitable access to COVID-19 vaccines worldwide.

Background: Mycobacterium tuberculosis infection usually manifests as pulmonary tuberculosis and rarely as extra-pulmonary tuberculosis (EPTB). In recent past, there is an increase in the cases of extra-pulmonary tuberculosis. The diagnostic difficulty owing to paucibacillary nature of EPTB poses a challenge in diagnosis and consequently treatment. In this scenario, Polymerase chain reaction (PCR) serves as a convenient tool which gives results within a short time along with other conventional methods in the diagnosis of extra-pulmonary tuberculosis. Aims: To detect Mycobacterium tuberculosis complex (MTBC) by DNA PCR in clinically suspected cases of EPTB. Materials and methods: Clinical samples from suspected cases of EPTB were collected and processed according to the standard guidelines. Smears prepared were subjected to Ziehl-Neelsen (ZN) staining. Nested PCR was performed on extracted DNA from homogenized samples using commercial kit with MTB target gene of IS6110. Results: A total of 156 samples were received for molecular diagnosis of EPTB over a year. They were all subjected to ZN staining and PCR test. All 156 samples were negative for AFB by ZN staining. Out of total 156 samples, 8(5.12%) samples were detected positive by MTB-DNA PCR test. The most common site of EPTB found in this study was pleura (14.28%). Other sites included genito-urinary tract (13.33%), CNS (4.65%) and endometrium (3.44%). Conclusion: Early diagnosis and treatment of EPTB reduces complications and morbidity in affected patients. Though PCR is expensive; in diagnostic dilemma in suspected cases of EPTB, it can be included in diagnostic panel to clinch the diagnosis early and start pre-emptive treatment.

BACKGROUND: Aphis craccivora is the major sap‐sucking pest of leguminous crops and vector of plant viruses that cause damage to plants and reduce yield. Indiscriminate and nonjudicious use of synthetic insecticides led to resistance development and harmful to environment. Therefore, it is important to discover plant‐based lead(s) which can replace synthetic insecticides. In the current study the residual toxicity of extracts, fractions, and isolated compounds of Aconitum heterophyllum were evaluated against A. craccivora to identify lead(s) for further development of botanical formulation. RESULTS: In residual contact assay, ethanolic (LC50 = 2837.17 mg L−1) and aqueous methanolic extracts (LC50 = 2971.59 mg L−1) were effective against A. craccivora. Among fractions, the n‐butanol fraction of the aqueous methanolic extract (LC50 = 986.96 mg L−1) was found to be most effective, followed by the ethyl acetate fraction of the ethanolic extract (LC50 = 1037.52 mg L−1) and the n‐hexane fraction of both extracts (LC50 = 1113.85 to 1233.11 mg L−1). Among pure molecules, aconitic acid was found to be the most effective (68% mortality; LC50 = 1313.19 mg L−1) and was on a par with azadirachtin 0.15% EC (66% mortality; LC50 = 1921.10 mg L−1). Furthermore, from the effect of ethanoic extract on detoxification enzyme inhibition in A. craccivora we concluded that the target site of action of this extract in A. craccivora might be glutathione S‐transferase. CONCLUSIONS: The parent extract/fractions of A. heterophylum showed promising activity against A. craccivora. Among phytoconstituents of the active extract and fractions, aconitic acid was found to be on a par with azadirachtin 0.15% EC. © 2022 Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Has China's remarkable reduction in income poverty since 1980 been accompanied by comparable progress in health? The author's findings are fourfold. First, province-level rates of improvement in life expectancy (LE) were higher in the 1990s than in the 1970s and 1980s, and were lowest in the 1980s. Second, even in the 1990s, when the province-level rates of improvement in LE were highest, they were lower than for many countries with similar initial LE level (although higher than the average for all such countries). Third, China's LE improvement between 1980 and 2000 was achieved much more quickly by almost all other countries considered, and in particular by most lower-middle-income countries that had similar LE improvements; similar conclusions are drawn from an analysis of China's LE improvements relative to two other sets of comparator countries--selected presently rich countries and high-growth East Asian countries. Finally, even those Chinese provinces that performed best over the period experienced rates of improvement significantly lower than for comparator countries. China's experience of reducing health deprivations has been notably less impressive than its record of income poverty reduction. There is a need for China to invest in the redevelopment of its public health infrastructure, which has withered during the period of market-oriented reforms. [ABSTRACT FROM AUTHOR]

BACKGROUND: Free radical-induced oxidative stress is the root cause for many human diseases. Naturally occurring antioxidant supplements from plants are vital to counter the oxidative damage in cells. The main objective of the present study was to characterize the antioxidant and antiproliferative potential of rice bran extracted from an important Indian rice variety, Njavara and to compare the same with two commercially available basmati rice varieties: Vasumathi, Yamini and a non medicinal variety, Jyothi. METHODS: Methanolic extracts of rice bran from four varieties; Vasumathi, Yamini, Jyothi and Njavara were used to study their total phenolic and flavonoid contents, in vitro antioxidant activities including total antioxidant activity, scavenging of nitric oxide and 1,1-Diphenyl-2-picrylhydrazyl (DPPH) radical, reducing power and cytotoxic activity in C6 glioma cells. Correlation coefficient and regression analysis were done by using Sigmastat version 3.1 and Stata statistical package respectively. RESULTS: Rice bran methanolic extract from Njavara showed the highest antioxidant and cell cytotoxic properties compared to the other three rice varieties. IC50 values for scavenging DPPH and nitric oxide were in the range of 30.85-87.72 microg/ml and 52.25-107.18 microg/ml respectively. Total antioxidant activity and reducing power were increased with increasing amounts of the extract. Total phenolic and flavonoid contents were in the range of 3.2-12.4 mg gallic acid-equivalent (GAE)/g bran and 1.68-8.5 mg quercetin-equivalent (QEE)/g bran respectively. IC50 values of cytotoxic assay (MTT assay) were 17.53-57.78 microg/ml. Correlation coefficient and regression analysis of phenolic content with DPPH and NO scavenging, MTT (-[4,5-dimethylthiazol-2-yl]-2,5-diphenyl tetrazolium bromide) assay, total antioxidant assay and reducing power showed a highly significant correlation coefficient values (96-99%) and regression values (91-98%). CONCLUSION: The results of the present study show that the crude methanolic extract from Njavara rice bran contains significantly high polyphenolic compounds with superior antioxidant activity as evidenced by scavenging of free radicals including DPPH and NO. Njavara extracts also showed highest reducing power activity, anti-proliferative property in C6 glioma cells. In conclusion, it is conceivable that the Njavara rice variety could be exploited as one of the potential sources for plant--based pharmaceutical products. [ABSTRACT FROM AUTHOR]

These diverse outcomes of Covid-19 are influenced by various factors including age, gender, underlying health conditions, immune responses, viral variants, external factors, and overall quality of life. Demographic analysis of patients aged 0-18 years experienced mild to moderate cases, above 55 years with co-morbidities, were more severely affected.COVID-19 incidence was higher in males (58 %) & (42 %) in females. The reduced expression of Toll-like receptors (TLR) in severe and critical patients is a crucial determinant. This reduced TLR expression is primarily attributed to the dominance of the PLpro viral protein of COVID-19. Disease enrichment analysis highlights the long-term impact of COVID-19, which can lead to post-recovery complications such as hypertension, diabetes, cardiac diseases, and brain ischemia in Covid-19 patients. In conclusion, a comprehensive strategy targeting key factors like PLpro, TLR, and inflammatory cytokines such as IL-1 and IL-6 could offer an effective approach to mitigate the devastating effects of COVID-19., 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 Inc. All rights reserved.)

Introduction: Increasing evidence suggests that autoimmune disorders and their immunomodulating medications may increase the risk of rhinosinusitis compared to rhinitis., Goal: To investigate the association between autoimmune disorders and rhinosinusitis., Methods: We performed a case-control study of patients referred to West Virginia University from August 2020 to October 2022 for rhinologic complaints. Rhinosinusitis patients were diagnosed with either chronic rhinosinusitis (CRS) or recurrent acute rhinosinusitis (RARS). These patients were compared to non-rhinosinusitis patients. Patients' characteristics, comorbidities, and type of treatment of autoimmune disorders were reviewed., Results: The sample consisted of 527 rhinosinusitis [184 CRS without nasal polyps (CRSsNP), 263 CRS with nasal polyps (CRSwNP) and 80 RARS patients] patients and 564 non-rhinosinusitis patients. Patients with rhinosinusitis were more likely to be older, males, have asthma, and have current and past smoking history (all with p-value < 0.05). Autoimmune disorders, primary antibody deficiency, and immunomodulator agents were more common in rhinosinusitis patients (16.5 % vs 9.4 %, OR = 1.9, p < 0.001; 5.1 % vs 0.5 %, OR = 10.1, p < 0.001; and 3.8 % vs 1.1 %, OR = 3.7, p = 0.003 respectively). Multivariate logistic regression adjusting for confounders showed that autoimmune disorders were strongly associated with rhinosinusitis [OR = 1.6, 95 % CI = 1.10-2.48], whereas the immunomodulators did not reach statistical significance [OR = 2.4, 95 % CI = 0.87-6.47]. Subgroup analysis showed the autoimmune disorders did not significantly differ between CRS and RARS groups [OR = 1.0, 95 % CI = 0.5-2.1], or between the CRSsNP and CRSwNP groups [OR = 0.9, 95 % CI = 0.5-1.7]., Conclusion: Autoimmune disorders are associated with rhinosinusitis, both CRS and RARS, independently of other risk factors., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest/competing interests., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Extramammary Paget disease is a rare dermatological condition resembling Paget disease that occurs most commonly in the anogenital area and axilla. We present the case of an elderly male who had come with complaints of an itchy, erythematous and raised lesion in the perianal region for 3 months that did not respond to antifungals. A biopsy was taken from the lesion site and the diagnosis was confirmed by histopathological examination. It is important to be aware of conditions like extramammary Paget disease when an elderly individual presents with a non-specific pruritic lesion in the perianal area that is non-responsive to treatment; the diagnosis of which can be made only by doing a biopsy from the concerned site. This highlights the importance of histopathological examination in such ambiguous cases., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Ocular hypertelorism (OH) was initially considered as un-differentiated congenital cranio-facial deformity, however, I.T Jackson mentioned it as teleorbitism, considering it as increase in the inter-canthal width, inter-pupillary as well as inter-orbital distance as a result of lateralization of the orbital complex in total. Furthermore, Sailer further refined it and included the distance from the lateral orbital wall, i.e. he denoted increased inter-orbital distance along with the distance between lateral orbital walls as true hypertelorism. This condition is rare and is seen in association with midline congenital defects affecting the cranio-facial region., Classification and Review of Cases: The ideal time for the OH correction is usually between 5 and 8 years of age. However, the management of OH is complex, and several techniques have been described in literature for the same. Here, we describe our classification of OH, along with the evolution of the surgical aspects, the key treatment principles we follow, together with the types of the osteotomies and their indications. Furthermore, we delineate the four main principles that we have set for OH management., Results: Though the improvement in appearance is seen immediately post-surgery, however, this challenging surgery faces a multitude and common postoperative complications which have been represented in this article. The surgeon needs both the technical expertise and an inclination towards aesthetics for the execution of such procedures., Conclusion: It is preferred that the management of OH should be individualized as per the stage of the craniofacial growth and the psychosocial needs of the patient and the parents., Competing Interests: Conflict of interestThere are no potential conflicts of interest to declare., (© The Association of Oral and Maxillofacial Surgeons of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Montelukast Sodium (MK) is a leukotriene receptor antagonist, an oral drug generally prescribed to control chronic asthma symptoms. This research aims to provide the transdermal delivery of this drug in a controlled release profile as a better mode of drug delivery, specifically for the pediatric and elderly population. Transdermal delivery of the drug not only improves the drug's bioavailability but also maintains the concentration of the drug in the plasma without increasing the frequency of the drug dosage. Transdermal film formulations were developed using sodium alginate (SA) and lignosulphonic acid (LS) as the matrix and PEG-400 or Glycerine (Gly) as the plasticizers. Various physiochemical characteristic evaluations of the formulated films were conducted, revealing that the formulation with Glycerine as the plasticizer had a smooth surface and was flexible. It was observed that this formulation had the highest moisture uptake capacity and the lowest moisture loss capacity when compared with the other two formulations. It was also observed that the barium chloride cross-linked formulation had a higher swelling index when compared with calcium chloride cross-linked films. The surface pH of all the formulations was monitored to be around 7.5. In the in vitro release studies, the cross-linked films showed a controlled release over 36 h compared with the non-cross-linked films. Based on the observations and results, the cross-linked film formulation showed a better-controlled release of the drug and could potentially increase its bioavailability. TGA analysis of the polymeric mixture demonstrated the thermal stability of the SA blends, which enhanced the flexibility of the SALS blend with Glycerine. XRD of samples confirmed the amorphous nature of SALS blends with Gly, which influences the flexibility of the blend. The blends are further investigated for morphology using SEM to test their compatibility with the drug., Competing Interests: The authors declare no conflict of interest., (© 2023 Published by Elsevier Ltd.)

Physicians are a notoriously difficult group to survey due to a low propensity to respond. We investigate the relative effectiveness of reminder phone calls, pre-notification postcards, mailed paper surveys, and $1 upfront incentives for boosting survey response rate by embedding a randomized experiment into a mixed-mode operational survey at the American Board of Internal Medicine in 2019. Expected response rates and average marginal effects for each follow-up method were computed from a logistic regression model. The control group which only received email reminders achieved a response rate of 18.2%, 95% CI: (15.0%, 21.9%). The intervention group which included reminder emails, pre-notification postcards, and mailed paper surveys with $1 incentives achieved a response rate of 43.1%, 95% CI: (38.8%, 47.5%). Mailed paper surveys yielded the largest percentage point increase in response rate of 11.2%, 95% CI: (7.3%, 15.2%), while $1 upfront monetary incentives and phone call reminders increased survey response rate by 5.9%, 95% CI: (1.6%, 10.2%) and 5.5%, 95% CI: (2.6%, 8.3%) respectively. Pre-notification postcards are associated with a 2.0%, 95% CI: (-1.7%, 5.6%) increase in survey response rate. Cost-effectiveness for each method is discussed. This research supports optimal decision making for researchers when planning a physician survey study.

The aim of this systematic review was to establish the effect of different surgical repairs for the lip on nasal symmetry. PubMed, Scopus, Embase, Cochrane CENTRAL, and Ovid databases search was performed initially for only English-language articles, in patients with unilateral complete cleft lip with or without cleft alveolus and palate (UCCLAP) who were younger than 1 year of age and undergoing cleft lip repair, and are published from the earliest data available up to December 31, 2020. The primary outcome variable was nasal symmetry, with reported complications being secondary variables. A qualitative synthesis was provided. A total of 19,828 records were obtained, and 17 articles were selected for final review. Assessment of the risk of bias of the included randomized controlled trials (RCTs) (N-1) was done with the Cochrane Risk of Bias 2 (RoB-2) tool, and the ROBINS-I tool was used for non-randomized studies (n = 14). Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to evaluate the quality of the body of evidence. The majority of the included studies compared the triangular repair with the rotation advancement (RA) techniques, and preferred RA or its modifications. In terms of the nasal symmetry, the Fisher repair proved to be superior to the RA technique. Neither RA nor straight line repair was superior to one another. The Delaire technique may be preferred over the modified RA. Also, satisfactory outcomes were observed with simultaneous lip-nose repair. This systematic review examined a plethora of techniques, and the heterogeneity between studies was very high regarding type of surgery, method of nasal symmetry assessment, and length of follow-up, thus producing low-quality evidence; therefore, results should be interpreted with caution. Future research requires RCTs with larger sample sizes and appropriate length of follow-up, and surgeries preferably performed by a single experienced surgeon., Competing Interests: Declaration of competing interest None., (Copyright © 2023 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

The main aim of this study was to assess nasal symmetry after morphofunctional septorhinoplasty, more specifically, symmetry of the alar base and nostrils, and nasal projection, in patients with unilateral and bilateral cleft nasal deformities. Secondary cleft rhinoplasty was performed using morphofunctional septorhinoplasty techniques in 150 patients with unilateral and bilateral cleft lip and nose deformities. Nasal changes were analysed by measuring nasal tip projection, nostril height, nostril width, alar base width, and nasal gap area preoperatively and postoperatively on standard submentovertex view 2-dimensional photographs. In the unilateral cleft group there were statistically significant improvements (p<0.001) in ratios of nasal height and width (p=0.024) and nasal gap area, and in nasal tip projection and alar base width. In the bilateral cleft group there were statistically significant improvements in nasal gap area ratio (p=0.009), nasal tip projection, and alar base width. The morphofunctional septorhinoplasty technique improved aesthetic outcomes., (Copyright © 2021 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: Mandibular pathologies causing extensive defects in pediatrics is relatively rare, and sparse literature is available for the reconstructive options of the same. The main aim is to provide optimum esthetics and function., Materials and Methods: PubMed, Cochrane CENTRAL, Embase, MEDLINE and Scopus databases were searched for articles published only in English language up to May 2021, involving reconstruction of hemi or total mandibulectomy defects in patients with the age of 8 years or less, associated with benign or malignant pathology. Primary outcome variable was the success of reconstruction. Qualitative analysis was performed using a microsoft excel-sheet., Results: Of the 2201 articles reviewed, only fourteen were selected for data extraction. 22 patients were included. Fifteen were benign, six were malignant pathologies, and one was not defined. Hemi-mandibulectomy was performed in twenty-one cases, while one underwent total mandibulectomy. Condyle was preserved in five cases, while was removed in nine. Single-stage reconstruction was done in nineteen cases, while second-stage reconstruction was done in the other three. Reconstruction was done with fibular graft in thirteen cases, while CCG was used in others with variable follow-up time. Though minor complications were observed, success was observed in all cases post reconstruction with either fibula or CCG graft, defined either by function, or growth., Conclusion: Irrespective of the age-group, nature of pathology and size of the defect, reconstruction should be considered with either fibula or CCG in single-stage, as they are equally efficacious, with minor complications. Well-defined reconstructive paradigm should be developed for pediatric mandibular reconstruction., Competing Interests: There is no conflict of interest to declare from any of the authors., (© 2022 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Many pathogens can cause cancer, but cancer itself does not normally act as an infectious agent. However, transmissible cancers have been found in a few cases in nature: in Tasmanian devils, dogs, and several bivalve species. The transmissible cancers in dogs and devils are known to spread through direct physical contact, but the exact route of transmission of bivalve transmissible neoplasia (BTN) has not yet been confirmed. It has been hypothesized that cancer cells from bivalves could be released by diseased animals and spread through the water column to infect/engraft into other animals. To test the feasibility of this proposed mechanism of transmission, we tested the ability of BTN cells from the soft-shell clam ( Mya arenaria BTN, or MarBTN) to survive in artificial seawater. We found that MarBTN cells are highly sensitive to salinity, with acute toxicity at salinity levels lower than those found in the native marine environment. BTN cells also survive longer at lower temperatures, with 50% of cells surviving greater than 12 days in seawater at 10 °C, and more than 19 days at 4 °C. With one clam donor, living cells were observed for more than eight weeks at 4 °C. We also used qPCR of environmental DNA (eDNA) to detect the presence of MarBTN-specific DNA in the environment. We observed release of MarBTN-specific DNA into the water of laboratory aquaria containing highly MarBTN-diseased clams, and we detected MarBTN-specific DNA in seawater samples collected from MarBTN-endemic areas in Maine, although the copy numbers detected in environmental samples were much lower than those found in aquaria. Overall, these data show that MarBTN cells can survive well in seawater, and they are released into the water by diseased animals. These findings support the hypothesis that BTN is spread from animal-to-animal by free cells through seawater.

This parallel blocked randomized controlled trial was done in two groups of 30 patients each to determine if placement of an antibiotic oral pack on the hard palate after hard palatal fistula repair reduces nasal air emission and fistula re-occurrence. Group A had an oral pack on the hard palate for 5 days post-operatively while group B did not. In group A, percentage of nasal air emission was tested using nasometry with and without pack. Paired t-tests were performed to compare nasal emissions for patients with and without pack. Recurrence of fistulas after 6 months between group A and B was tested using odds ratio. Effect of nasal air emission on fistula rates was tested using paired t-tests. There was a significant increase (p < 0.0001) in nasal emission after removal of the pack in group A. Fistula re-occurrence tended to be higher in group B (no pack) than group A but this was not significant (p = 0.242). There was no correlation between nasal air emission and fistula rates. In patients with recurrent fistulae, placement of an oral pack after fistula repair diminishes nasal air emission. Whether this has an impact on re-occurrence of fistulae needs to be investigated further., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Aim: This study aimed to systematically review available literature of in vitro studies on apical extrusion of debris through rotary instrumentation in comparison to manual instrumentation in pediatric endodontics, and also to perform a comparison between various rotary instrumentation systems for assessment of debris extrusion., Materials and Methods: A comprehensive search was conducted on PubMed, Medline, Cochrane Library, Embase, Scopus, and Google Scholar without any language restriction and year of publication. A planned search strategy was made for PubMed and applied to other databases. After full-text reading, 7 articles were selected for quantitative synthesis. Modified CONSORT checklist of items for reporting in vitro studies of dental materials was used for quality assessment of included studies., Results: Root canal preparation with rotary instrumentation led to lesser apical debris extrusion than manual instrumentation. Self-adjusting file system was associated with the least debris extrusion among all included studies, followed by ProTaper Next, Kedo-S, ProTaper, K3, Mtwo, Revo-S, and Wave One., Conclusion: More apical debris extrusion was seen with manual instrumentation than rotary instrumentation. Furtrhermore, variance in debris extrusion was seen with different rotary file systems., Competing Interests: None

Among anesthesia-related life-threatening complications, respiratory failure requiring reintubation is common. However, studies evaluating patient characteristics for extubation failure are scarce in the literature. Such knowledge is important to increase awareness and for the development of strategies to improve the safety of anesthesia care. We retrospectively reviewed 196 cases that were reported to our quality assurance (QA) committee from 2004 to 2014 at 3 hospitals. The reintubation rate was 0.09% (n=196). More reintubations occurred in the operating room than the postanesthesia care unit (58% vs 30%). Ninety-three reintubated patients (47%) were 65 years or older. Most patients were in ASA class 3 or 4 (76%) and had a surgical procedure lasting longer than 3 hours. Eleven reintubated patients (5%) died during the hospital course. The exact causes of reintubation could not be determined because of limited data in our QA database. We conclude that although the individual risk of reintubation for each patient is low, the reintubated patients have a higher mortality rate. The study findings emphasize the need for extra vigilance before anesthesia providers attempt extubation of a patient who is elderly, underwent surgery over 3 hours, has chronic obstructive airway disease, or has ASA class 3 or 4 status., Competing Interests: Name: Ratan K. Banik, MD, PhD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, University of Minnesota. Name: Kate Honeyfield, BA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, University of Minnesota. Name: Sana Qureshi, MD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. Name: Shamantha G. Reddy, MD, FASA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: Partly supported by the Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York. The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request., (Copyright © by the American Association of Nurse Anesthetists.)

Objectives: The aim of this study was to determine Relapse and TMD as postoperative complication in skeletal class III patients undergoing bimaxillary orthognathic surgery., Materials and Methods: Data was obtained by database searching using The Cochrane Central Register of Controlled Trials (central), PUBMED, SCOPUS, EMBASE, Google scholar, National Medical library, New Delhi. The titles and abstracts of the electronic search results were screened and evaluated by two observers for eligibility according to the inclusion and exclusion criteria., Results: 5261 articles were retrieved for the review. Among these, 3474 duplicate articles were removed. 418 studies were selected based on the eligibility criteria. For the present review, 30 articles were included after elimination according to the inclusion criteria. The Prisma diagram flowchart demonstrates our selection scheme. Quality assessment criteria to evaluate the studies were decided by two review authors in accordance with CONSORT guidelines. Each study was assessed using the evaluation method described in the Cochrane Handbook for Systematic Reviews. Among the 30 studies included in the review, marked degree of relapse in the mandible was noted from 3 months - 1 year postoperatively in 8 studies, 5 studies reported both TMD prevalence and relapse, whereas only 4 studies reported TMD disorder alone., Conclusion: Complications of relapse and TMD are associated with bimaxillary orthognathic surgery procedures. More RCTs and CCTs are needed in this regard to get better quality evidence. This review was registered with PROSPERO: CRD42020211342., (© 2021 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

This article represents the point of view and philosophy of GSR Institute of Craniomaxillofacial and Facial Plastic Surgery (GSRIFCS) in the management of craniofacial and cleft patients. GSRICFS is a 50 bedded state of art high volume cleft centre in Hyderabad which has accomplished greater than 30000 cleft surgeries. Cleft surgery in India has improved greatly over the last 70 years since the innovations of the Colombo plan to now, resulting in better healthcare facilities, research and transfer of knowledge globally. In this period, the deprivations of the past, due to lack of available, accessible or affordable care or awareness of outpatients and their parentage, of the possibilities, some of cultural origin such as various superstitions leading to isolation and social stigma, have been largely but not completely overcome. There were minimal centres in the past, which provided care, and this was partly due to scarcity of funding, lack of training and non-sustainability of skilled human recourses. Surgery for cleft requires not only a sophisticated infrastructure, but instrumentation, specialized anesthetists and high-end post-operative care along with a multidisciplinary team involving surgeons, anesthetists, paediatricians, psychologists, orthodontists and specialized nurses for optimal outcomes. The article elaborates the vision, mission and plan in establishing the GSRICFS and how it might form a model for the future of cleft care in LMICs., Competing Interests: There is nothing to declare.There is no conflict of interest to declare from any of the authors., (© 2021 Published by Elsevier B.V. on behalf of Craniofacial Research Foundation.)

For survey researchers, physicians in the United States are a difficult-to-reach subgroup. The purpose of this study is to quantify the effect of email reminders on web-based survey response rates targeting physicians. We conducted a retrospective analysis of 11 American Board of Internal Medicine surveys from 2017 to 2019. We compute aggregate response rates for the periods between weekly email contacts across the 11 surveys, while controlling for survey time to complete, physician age, gender, region, board certification status, and initial exam performance. The overall predicted response rate after six weekly email contacts was 23.7%, 95% CI: (17.1%, 33.0%). Across the 11 surveys, we found response rate for the first period to be 8.9%, 95% CI: (6.5%, 12.2%). We observed a 50% decrease in response from the first to the second period, which had a 4.4%, 95% CI: (3.2%, 6.2%), response rate. The third and fourth response periods yielded similar response rates of 3.0%, 95% CI: (2.3%, 3.9%) and 3.3%, 95%CI: (2.4%, 4.6%), respectively. The fifth and sixth response periods yielded similar response rates of 2.2%, 95%CI: (1.5%, 3.3%) and 1.9%, 95% CI: (1.3%, 2.7%), respectively. The results were further stratified into different levels of participant survey interest, and are helpful for cost and sample size considerations when designing a physician survey.

The paper reviews various classifications and surgical techniques for the treatment of temporomandibular joint ankylosis. PubMed, EBSCO, Web of Science, and Google Scholar were searched using a combination of keywords. Articles related to classification, resection-reconstruction of the temporomandibular joint, and management of airway obstruction were considered and categorized based on the objectives. Seventy-nine articles were selected, which included randomized clinical trials, non-randomized controlled cohort studies, and case series. Though several classifications exist, most classifications are centered on the radiographic extent of the ankylotic mass and do not include the clinical and functional parameters. Hence there is a need for a comprehensive staging system that takes into consideration the age of the patient, severity of the disease, clinical, functional, and radiographic findings. Staging the disease will help the clinician to adopt a holistic approach in treating these patients. Interpositional arthroplasty (IA) results in better maximal incisal opening compared with gap arthroplasty, with no significant difference in recurrent rates. Distraction osteogenesis (DO) is emerging as a popular technique for the restoration of symmetry and function as well as for relieving airway obstruction. IA, with a costochondral graft, is recommended in growing patients and may be combined with or preceded by DO in cases of severe airway obstruction. Alloplastic total joint replacement combined with fat grafts and simultaneous osteotomy procedures are gaining popularity. A custom-made total joint prosthesis using CAD/CAM can efficiently overcome the shortcomings of stock prostheses.

Introduction: The objective was to compare the clinical efficacy of silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) in arresting active caries in primary teeth and first permanent molars in children., Materials and Methods: The study protocol was registered in PROSPERO (CRD42020205675). A systematic search was performed in PubMed, Scopus, Embase, Cochrane Library, and gray literature for randomized controlled trials (RCTs) published in English language with a minimum follow-up of 6 months, comparing the caries arrest potential of SDF with ART in primary teeth and first permanent molars in children. The risk of bias and quality assessment of the studies was done using the Cochrane Collaboration Tool and Joanna Briggs Institute Critical Appraisal Tool. Data analysis was performed using RevMan software; the outcomes were summarized in meta-analysis (MA) using the random-effects model, and the odds ratio (OR) at 95% confidence interval (CI) was computed., Results: A total of 1059 studies were identified, out of which 562 remained after removal of duplicates. Eight studies were considered for full-text eligibility, and four studies were included in the qualitative review. Three out of four studies were conducted on primary dentition, whereas one study was done on erupting first permanent molars in children. MA of the two studies compared 30% SDF with ART in primary molars at 12 months and revealed the OR to be 2.02 (95% CI: 0.86-4.71; I 2 = 62%; P = 0.10)., Conclusion: The current review points to the lack of solid evidence comparing SDF with ART for arresting active caries in primary teeth, especially in the first permanent molars. No statistically significant difference between 30% SDF and ART in primary molars at 12 months was found in the present review. Well-designed RCTs are required to determine a minimum concentration of SDF which is effective and safe for caries arrest in children., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of International Society of Preventive and Community Dentistry.)

Objectives: Eleven months into the coronavirus disease 2019 pandemic, the country faces accelerating rates of infections, hospitalizations, and deaths. Little is known about the experiences of critical care physicians caring for the sickest coronavirus disease 2019 patients. Our goal is to understand how high stress levels and shortages faced by these physicians during Spring 2020 have evolved., Design: We surveyed (October 23, 2020 to November 16, 2020) U.S. critical care physicians treating coronavirus disease 2019 patients who participated in a National survey earlier in the pandemic (April 23, 2020 to May 3, 2020) regarding their stress and shortages they faced., Setting: ICU., Patients: Coronavirus disease 2019 patients., Intervention: Irrelevant., Measurement: Physician emotional distress/physical exhaustion: low (not at all/not much), moderate, or high (a lot/extreme). Shortage indicators: insufficient ICU-trained staff and shortages in medication, equipment, or personal protective equipment requiring protocol changes., Main Results: Of 2,375 U.S. critical care attending physicians who responded to the initial survey, we received responses from 1,356 (57.1% response rate), 97% of whom (1,278) recently treated coronavirus disease 2019 patients. Two thirds of physicians (67.6% [864]) reported moderate or high levels of emotional distress in the Spring versus 50.7% (763) in the Fall. Reports of staffing shortages persisted with 46.5% of Fall respondents (594) reporting a staff shortage versus 48.3% (617) in the Spring. Meaningful shortages of medication and equipment reported in the Spring were largely alleviated. Although personal protective equipment shortages declined by half, they remained substantial., Conclusions: Stress, staffing, and, to a lesser degree, personal protective equipment shortages faced by U.S. critical care physicians remain high. Stress levels were higher among women. Considering the persistence of these findings, rising levels of infection nationally raise concerns about the capacity of the U.S. critical care system to meet ongoing and future demands., Competing Interests: Dr. Liper disclosed that she is employed by the American Board of Internal Medicine, and disclosed work for hire. She received funding for article research from the Senior Vice President Assessment and Research American Board of Internal Medicine. Dr. Landon received funding from the American Board of Internal Medicine (ABIM), Research Triangle Institute, Freedman Healthcare Consulting, and ABIM; he received Federal grants from the National Institute on Aging, Agency for Health Research and Quality, and National Cancer Institute and received funding for article research from ABIM. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2021 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)

Background: Orofacial cleft, one of the most common congenital deformities, presents with a plethora of defects, subjecting the patient to a multitude of treatments from a young age. Among the oral hard tissue problems, absence of a maxillary permanent tooth in the cleft region either due to congenital absence or extraction due to compromised prognosis is a common finding. Conventionally, the missing tooth is replaced using a removable or fixed partial denture; however, the treatment modality does not satisfactorily meet patient expectations. The most recent decade has seen increasing use of dental implants in the cleft region; however, the outcome of an immediately loaded dental implant is still elusive for orofacial cleft patients., Objective: This protocol is for a single-arm clinical trial aimed at determining the treatment outcome of immediately loaded dental implants in patients with a nonsyndromic orofacial cleft., Methods: Patients meeting the set criteria will be sequentially enrolled until a sample size of 30 dental implants is met and will undergo the proposed treatment according to the predecided protocol. All patients will be followed up at the designated time intervals to record various clinical and radiographic parameters. Implant success will be defined based on the criteria elucidated by Misch et al in the Pisa, Italy Consensus. A quality-of-life assessment questionnaire will also be recorded at the end of patient's follow-up to determine their acceptance of the treatment., Results: A total of 30 dental implants will be placed in patients with a nonsyndromic orofacial cleft. Obtained results will be statistically analyzed to determine the treatment outcomes and success., Conclusions: This study will help determine the feasibility of immediately loaded dental implants in compromised bone sites such as those presented in cleft patients and will help in generating findings that can be used to fill the lacunae currently present in the holistic treatment of cleft patients., Trial Registration: Clinical Trial Registry of India CTRI/2020/09/027997; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47659&EncHid=&userName=dental%20implants., International Registered Report Identifier (irrid): PRR1-10.2196/25244., (©Rizwana Mallick, Sweta Kale Pisulkar, Srinivas Gosla Reddy. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.05.2021.)

Capital and Ideology represents a significant further statement from Thomas Piketty. The arguments made by the "New Piketty" are largely compatible with those of his previous Capital in the Twenty-First Century, but reflect broadening of scope and deepening of causal analysis, most markedly through the adoption of a world historical perspective. The result is a fuller offering for understanding inequality's pattern in the world, why it exists and how we can best respond to it. The book presents a wide range of arguments, which do not on first glance appear unified. This review essay distills these into six propositions, describes and evaluates each in turn, and identifies some threads that link them. In the process, it provides a critical assessment of Capital and Ideology., (© 2021 London School of Economics and Political Science.)

Abstract: Cleft lip and palate (CLP) is one of the most common congenital deformities. Primary surgeries at an early age result in scar formation, which may impede the growth of craniofacial structures of the maxilla. Orthodontist's role in the management of individuals with CLP is important and starts from the time of birth. The knowledge of craniofacial structures in individuals with a cleft is essential for treatment planning. The purpose of this study was to analyze and compare craniofacial structures of cleft and noncleft side of individuals with non-syndromic unilateral complete cleft lip and palate (NSUCCLP) using cone-beam computed tomography (CBCT). CBCT scans of individuals with NSUCCLP (n = 42) were retrieved from the databases of two cleft centers, which followed the same protocols for timing and type of primary surgeries and secondary alveolar bone grafting (SABG). DICOM files of CBCT scans were integrated into Dolphin 3D software, and analysis was carried out in multiplanar views. The craniofacial structures of individuals with NSUCCLP were analyzed using fourteen parameters. Measurements were also recorded between the cleft and noncleft sides for comparison. The volume of the maxilla was generated by isolating it from adjacent structures on a 3D reconstructed model. MAWC, MAWPM1, MAWPM2, MAWM1, and MV of the cleft side was less than noncleft side (P < 0.05). MHP @ N Aper is less on the noncleft side (P < 0.05). There is an asymmetry of structures around the dentoalveolar and nasal region; however, asymmetries were not affected at deeper structures of the craniofacial region of individuals with NSUCCLP., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 by Mutaz B. Habal, MD.)

Purpose: The aim of this study was to introduce a morpho-functional technique of rhinoplasty for correction of defective nasal morphology of the secondary unilateral cleft lip and improvement of air passage through the nose., Materials and Methods: The described comprehensive approach follows the rule of 5 R's: relieve, resect, reposition, restructure, and restrengthen. The extended septal graft serves as a columellar strut on the one hand and as a spreader graft on the other hand., Results: The described morpho-functional septorhinoplasty technique is effective for correction of the unilateral cleft lip nasal deformity because it improves the symmetry of the nose, improves the morphology of the alar cartilage, and increases the nasal tip projection. An improvement in breathing occurs as a result of restored symmetry of the ala and nasal vestibule., Conclusions: Morpho-functional septorhinoplasty is a practical tool to handle adult patients with secondary cleft nasal deformities., (Copyright © 2020 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objectives: To compare the postoperative outcomes in impacted mandibular third molar extraction using piezosurgery and conventional rotary technique; and to assess the stress levels in both the techniques by measuring salivary cortisol levels., Methods: Ten patients with symmetrical impacted lower third molars were included in this split mouth pilot study. Measurements for mouth opening and swelling were taken preoperatively on the day of surgery and 1 week after surgery. Pain was evaluated using Visual Analog Scale (VAS) from first postoperative day for six consecutive days. Saliva collection for analysis of cortisol levels was done at four time intervals - before starting the procedure, immediately after the procedure, 20 min and 1 week later. The mean in two groups was compared using paired t-test/Wilcoxon signed rank test as applicable. Friedman test was used to compare multiple readings of pain and salivary cortisol., Results: Reduction in mouth opening was more in rotary group than piezosurgery group but was not statistically significant (p = 0.092). Increase in facial swelling was more in the rotary group than piezosurgery group with statistically significant values (p = 0.020). Rotary group had higher values for postoperative pain as compared to piezosurgery on all the days and the difference was statistically significant on each day except second postoperative day. Salivary cortisol levels were elevated in both the groups with the mean values higher in group I (rotary) than in group II (Piezosurgery)., Conclusion: Extraction of impacted lower third molar results in more favourable outcome when carried out by piezosurgery technique. Further studies are needed to compare the salivary cortisol response in rotary and piezosurgery techniques., Competing Interests: There is no conflict of interest to declare by the authors., (© 2020 Craniofacial Research Foundation. Published by Elsevier B.V. All rights reserved.)

Are the steps that have been taken to arrest the spread of COVID-19 justifiable? Specifically, are they likely to have improved public health understood according to widely used aggregate population health measures, such as Quality Adjusted Life Years (QALYs) and Disability Adjusted Life Years (DALYs) as much or more than alternatives? This is a reasonable question, since such measures have been promoted extensively in global and national health policy by influential actors, and they have become almost synonymous with quantification of public health. If the steps taken against COVID-19 did not meet this test, then either the measures or the policies must be re-evaluated. There are indications that policies against COVID-19 may have been unbalanced and therefore not optimal. A balanced approach to protecting population health should be proportionate in its effects across distinct health concerns at a moment, across populations over time and across populations over space. These criteria provide a guide to designing and implementing policies that diminish harm from COVID-19 while also providing due attention to other threats to aggregate population health. They should shape future policies in response to this pandemic and others., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Little is known about how board-certified physicians prepare for their periodic maintenance of certification (MOC) examinations. This qualitative study explores how physicians experience MOC exam preparation: how they prepare for the exams and decide what to study and how exam preparation compares with what they normally do to keep their medical knowledge current., Method: Between September 2016 and March 2017, the authors interviewed 80 primary care physicians who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine MOC exam. They analyzed transcripts and notes from these interviews looking for patterns and emergent themes, using the constant comparative method and a social practice theory perspective., Results: Most interviewees studied for their MOC exams by varying from their routines for staying current with medical knowledge, both by engaging with a different scope of information and by adopting different study methods. Physicians described exam preparation as returning to a student/testing mindset, which some welcomed and others experienced negatively or with ambivalence., Conclusions: What physicians choose to study bounds what they can learn from the MOC exam process and, therefore, also bounds potential improvements to their patient care. Knowing how physicians actually prepare, and how these activities compare with what they do when not preparing for an exam, can inform debates over the value of requiring such exams, as well as conversations about how certification boards and other key stakeholders in physicians' continuing professional development could improve the MOC process.

Context: Preeclampsia is often asymptomatic, and hence, its detection depends on signs or investigations. The platelet (PLT) parameters, in cases of preeclampsia with normal PLT count, are seldom analyzed. Hence, this study was undertaken to study the PLT parameters in nonthrombocytopenic preeclampsia cases., Aim: The aim was to evaluate the use of PLT indices as severity markers in nonthrombocytopenic preeclampsia cases., Subjects and Methods: This prospective study was done on 120 cases of severe preeclampsia, 115 cases of preeclampsia without severe features, and 203 normal pregnant women admitted in the obstetrics wards during the study period of 1 year. The PLT indices obtained by analyzing anticoagulated blood were recorded., Statistical Analysis Used: Analysis of variance test was used to see the significance of association. Receiver operating characteristic (ROC) curve and binary regression analysis was used to estimate the cutoff value and examine the predictive value of the PLT parameters in the disease progression of preeclampsia., Results: Even in the absence of thrombocytopenia, mean platelet volume (MPV) and PLT distribution width were significantly higher in severe preeclampsia group ( P < 0.001) and were also positively correlating with mean arterial pressure (r = 0.38 and 0.20, respectively). ROC curve analysis showed that MPV had the highest area under the curve of 0.78 (95% confidence interval [0.719-0.842]). Cutoff value of >10.95 fl for MPV was found to have significant predictive value for disease progression in preeclampsia., Conclusions: Even in the absence of thrombocytopenia, PLT indices, especially MPV, have a good diagnostic significance in detecting severe preeclampsia. Further studies are required to evaluate their role as biomarkers in preeclampsia., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 Journal of Laboratory Physicians.)

Background: Growing patients with cleft lip and palate (CLP) exhibit maxillary deficiency due to early surgical intervention. Maxillary protraction with expansion is the recommended treatment modality for deficient maxilla. Facemask is a conventional protraction appliance, and Maxgym is a new protraction appliance. The purpose of this study is to compare the efficacy of Maxgym with Facemask using finite-element analysis., Methods: A three-dimensional finite-element model consisting of 49,807 nodes and 185,620 tetrahedral-shaped elements was created using computed tomography scan of a patient with unilateral CLP. F1, F2, and F3 represent different protraction forces of facemask, and M1, M2, and M3 represent different protraction forces of Maxgym. E1 represents slow maxillary expansion (SME) force, and E2 represents rapid maxillary expansion (RME) force. Facemask and Maxgym forces were applied parallel to the occlusal plane from the middle of the clinical crown on the buccal side of the first premolars. The forces E1 and E2 were also applied on the middle of the crown height on the lingual side of the first premolars and the first molars to simulate expansion. The amount of displacement for Maxgym and Facemask forces in transverse direction was analyzed designating specific nodes to represent dental and skeletal structures., Results: The dental and skeletal structures were displaced in transverse direction under all loading conditions. Only expansion or protraction force resulted in transverse displacement of nodes. RME produces greater transverse displacement as compared to SME. Maxgym forces produce greater transverse displacement as compared to facemask. Maxgym with RME produces greater transverse displacement as compared to Maxgym with SME, whereas facemask with RME produces greater transverse displacement as compared to facemask with SME., Conclusions: Maxgym forces produce greater transverse displacement as compared to facemask with or without expansion., Competing Interests: None

Lineage analysis of autoreactive B cells can reveal the origins of autoimmunity. In the autoimmune disease pemphigus vulgaris (PV), desmoglein 3 (DSG3) and DSG1 autoantibodies are predominantly of the IgG4 subclass and less frequently of IgG1 and IgA subclasses, prompting us to investigate whether anti-DSG IgG4 B cells share lineages with IgG1, IgA1, and IgA2. Combining subclass-specific B cell deep sequencing with high-throughput antibody screening, we identified 80 DSG-reactive lineages from 4 PV patients. Most anti-DSG IgG4 B cells lacked clonal relationships to other subclasses and preferentially targeted DSG adhesion domains, whereas anti-DSG IgA frequently evolved from or to other subclasses and recognized a broader range of epitopes. Our findings suggest that anti-DSG IgG4 B cells predominantly evolve independently or diverge early from other subclasses and that IgA is most often not the origin of IgG autoreactivity in PV. These data provide insight into how autoreactivity diversifies across B cell subclasses., (Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: The objective of this study is to determine whether placement of an antibiotic oral pack on the hard palate reduces fistula rates after primary cleft palatoplasty., Subjects and Methods: This study was a parallel blocked randomized controlled trial. The study consisted of two groups of 100 patients each with non-syndromic unilateral complete cleft lip, alveolus, and hard and soft palate that underwent primary palatoplasty. Group A had an oral pack placed on the hard palate for 5 days postoperatively while group B did not. Occurrence of fistulae between both groups was tested using odds ratios (OR)., Results: In 2% of the patients in group A, a fistula was found 6 months after palatal surgery. In contrast, in 21% of the patients in group B, a palatal fistula could be confirmed. The fistula occurrence in group A was statistically significantly lower than that in group B (OR = 0.0768, CI = [0.02 … 0.34], p < 0.001)., Conclusion: The findings of this study provide evidence that the rate of fistula formation after primary palatoplasty is significantly reduced if a pack soaked with antibiotic cream is placed on the palate postoperatively for 5 days., Clinical Relevance: The use of an antibiotic pack after cleft palate repair can be recommended to prevent occurrence of oronasal fistulae.

Background: Inappropriate use of antibiotics by clinicians leads to antibiotic resistance, and is a serious global health concern., Aim: The aim of this study was to determine antibiotic prescription practices of dental practitioners and their adherence to professional guidelines while treating oral health problems among children., Materials and Methods: All the dentists working in Jeddah were invited to participate and 126 dentists consented to be a part of this study. A two-part questionnaire was applied. First section explored the demographics and questions related to antibiotic use for certain dental clinical procedures, whereas the second section used five different clinical case scenarios to elicit the antibiotics prescription practices and adherence to professional guidelines by the dentists., Results: Amoxicillin (73.8%) was the most commonly preferred antibiotic for most of the orofacial infections among the dentists. The overall adherence to the professional guidelines ranged from 9.5 to 45%., Conclusions: A lack of consistency in the antibiotic prescription pattern among dentists in Jeddah and overall low adherence to the professional guidelines was observed.

We here demonstrate on both theoretical and experimental bases a method to recover the topological structure of a monochromatic optical field that has suffered diffuse transmission. This method consists of two steps: first, a linearly polarized sample beam is mixed with a coaxial Gaussian beam in orthogonal polarization states resulting in a Poincaré beam; second, a polarization-related spatial correlation function is considered and measured for the overall speckle field arising by optical diffusion. The singularities of the sample beam turn out to be imaged into the correlation function of the vector speckle field.