Search

Introduction: Incidence of mucormycosis has increased recently due to rapid spread of coronavirus disease 2019 (COVID-19), which is a hyper-ferritemic state paving a way for easy growth of mucor species. COVID-19 infection results in an immunocompromised state due to the steroid therapy administered to patients and the infection itself. The presence of co-morbidities makes patients more susceptible to acquire mucor infection. Mucormycosis spreads rapidly, associated with aggressive angioinvasion, leading to ischemic necrosis of surrounding tissues. Due to its rapid spread and angioinvasion, mucormycosis is associated with increased mortality and morbidity. Treatment Planning: Early diagnosis and proper treatment planning are crucial to prevent further spread of infection, where dentists play an important role. Discussion: This case series is mainly focused on patients reported to the oral medicine department with complaints of discomfort or mobility of teeth in the maxillary region while explaining the role of dentists in diagnosing and treating the disease.

Introduction: This article emphasizes the importance of pterygoid plates (PP) and their anatomical characteristics while adding points about the relation between PP asymmetry and resulting temporomandibular joint disorders (TMJD). Materials and Methods: This retrospective study analyzes 100 Cone Beam Computed Tomography images. Morphometric analysis of the shape, thickness, and angulation of PP and pterygoid fossae (PF) was done. Statistical analysis was performed using Paired t-test and ANOVA. Results: Five different shapes of PP were noted, the tapered form was more prevalent (P < 0.01), and the needle form had the least thickness, which is prone to fracture. Three different shapes of PF were noted, namely U, V, W. V shape was more common. Males had increased thickness than females in medial and lateral pterygoid (P = 0.005). Conclusion: Owing to their location and relations to their adjacent structures, PP plays a vital role during various surgical procedures. Oral and maxillofacial surgical procedure planning must be done following the evaluation of PP as there is an increased risk of complication due to PP fracture. PP gives attachment to a few muscles and ligaments essential for jaw movements. Any deviation of PP from normal may result in temporomandibular joint disorders.

Introduction: Sexual dimorphism plays a pivotal role in many instances, including solving medicolegal problems, anthropological studies, sorting out victims of natural calamities and man-made calamities. Among various parameters available for sexual dimorphism, structures of the oral cavity play an important role. The use of Cone Beam Computed Tomography (CBCT) is convenient and provides accurate measurements with the help of digital software. Aim: To determine the role of Greater Palatine Foramen (GPF), its Greater Palatine Canal (GPC) and relation with the adjacent structures like Naso-Palatine Foramen (NPF) and Lesser Palatine Foramen (LPF) in elucidating the level of sexual dimorphism using CBCT images, while enhancing the information on anatomy of Greater Palatine Foramen (GPF). Materials and Methods: This cross-sectional forensic odontology study was conducted in the Department of Oral Medicine and Radiology, CSI College of Dental Sciences and Research, Madurai, Tamil Nadu, India, and was performed using 50 males and 50 females CBCT images of patients between age 18 to 45. The CBCT data were collected from January 2021 till January 2022, and the obtained data were analysed from March 2022 till April 15, 2022. These were analysed using Planmeca imaging software. Measurements of GPF length, angulation with respect to Hard Palate (HP), relation between NPC and GPF, distance between GPC and Mid Maxillary Suture (MMS). Its relation to LPF and dimensions of GPF at opening of oral cavity were done. Finally, all measures were subjected to statistical analysis using IBM Statistical Package for the Social Sciences (SPSS), version 28.0. Independent t-test was used for analysis of difference between male and female measurements. Results: The GPC length on right (male:13.2570, female:12.3628) and left (male:12.8089, female:12.2780), angulation of GPC left (male: 61.1379, female: 57.4964), angle between GPF and NPC left (male: 28.6208, female: 26.5024), distance between GPC and MMS left (male: 15.1625, female: 14.5350) and Anteroposterior (AP) dimensions of GPF on right (male: 5.5402, female: 4.2314) and left-side (5.4934, female: 4.4576), Transverse (TR) dimension of GPF on right (male: 2.6752, female: 2.0528) and left (male: 5.4943, female: 4.4576) showed statistically significant difference between male and female CBCT images, while the measures were significantly higher in males. Conclusion: The CBCT images provided reliable measurements of the areas of interest. The present study results highlight a statistically significant difference between male and female, where males showed higher measurements in most instances. A more precise morphological measurement of GPF in relation to adjacent structures such as NPC, MMS proves to have sexual dimorphism in humans.

Acute myeloid leukemia is a malignant disease of the bone marrow. Because of its high morbidity, early diagnosis and prompt treatment are essential to save lives. This article describes the case reports of a 33-year-old female and a 60-year-old male who came to our dental hospital with gingival overgrowth, gingival bleeding, epistaxis, and facial swelling for about 1 week. After doing a thorough hematological examination, acute myeloid leukemia was diagnosed The oral health care professionals need to be able to recognize oral physiological characteristics, and, when identifying a change of normalcy, investigate it requesting additional tests or referring the patient to a specialized professional.

Objectives Informing research participants of the results of studies in which they took part is viewed as an ethical imperative. However, there is little guidance in the literature about how to do this. The Fluoxetine Or Control Under Supervision trial randomised 3127 patients with a recent acute stroke to 6 months of fluoxetine or placebo and was published in the Lancet on 5 December 2018. The trial team decided to inform the participants of the results at exactly the same time as the Lancet publication, and also whether they had been allocated fluoxetine or placebo. In this report, we describe how we informed participants of the results.Design In the 6-month and 12-month follow-up questionnaires, we invited participants to provide an email address if they wished to be informed of the results of the trial. We re-opened our trial telephone helpline between 5 December 2018 and 31 March 2019.Setting UK stroke services.Participants 3127 participants were randomised. 2847 returned 6-month follow-up forms and 2703 returned 12-month follow-up forms; the remaining participants had died (380), withdrawn consent or did not respond.Results Of those returning follow-up questionnaires, a total of 1845 email addresses were provided and a further 50 people requested results to be sent by post. Results were sent to all email and postal addresses provided; 309 emails were returned unrecognised. Seventeen people replied, of whom three called the helpline and the rest responded by email.Conclusion It is feasible to disseminate results of large trials to research participants, though only around 60% of those randomised wanted to receive the results. The system we developed was efficient and required very little resource, and could be replicated by trialists in the future.Trial registration number ISRCTN83290762; Post-results.

Tobacco industries have resorted to brand stretching to keep their brands visible through sale of non-tobacco products like elaichi (cardamom) and paan masala, as seen in television advertisements aired during Indian premier league matches. The direct and indirect forms of advertisements of tobacco products in digital media remains unchecked. Strict ban should be enforced as these advertisements lure children and the youth into consumption of tobacco products later in life. In addition to providing tobacco cessation services to patients, oral health professionals should be aware of the marketing strategies of tobacco companies so that we can advise governing authorities to enact new laws and enforce existing laws in order to curtail tobacco consumption in our country.

Introduction Patient and staff experiences are strongly influenced by attitudes and behaviours, and provide important insights into care quality. Patient and staff feedback could be used more effectively to enhance behaviours and improve care through systematic integration with techniques for reflective learning. We aim to develop a reflective learning framework and toolkit for healthcare staff to improve patient, family and staff experience.Methods & analysis Local project teams including staff and patients from the acute medical units (AMUs) and intensive care units (ICUs) of three National Health Service trusts will implement two experience surveys derived from existing instruments: a continuous patient and relative survey and an annual staff survey. Survey data will be supplemented by ethnographic interviews and observations in the workplace to evaluate barriers to and facilitators of reflective learning. Using facilitated iterative co-design, local project teams will supplement survey data with their experiences of healthcare to identify events, actions, activities and interventions which promote personal insight and empathy through reflective learning. Outputs will be collated by the central project team to develop a reflective learning framework and toolkit which will be fed back to the local groups for review, refinement and piloting. The development process will be mapped to a conceptual theory of reflective learning which combines psychological and pedagogical theories of learning, alongside theories of behaviour change based on capability, opportunity and motivation influencing behaviour. The output will be a locally-adaptable workplace-based toolkit providing guidance on using reflective learning to incorporate patient and staff experience in routine clinical activities.Ethics & dissemination The PEARL project has received ethics approval from the London Brent Research Ethics Committee (REC Ref 16/LO/224). We propose a national cluster randomised step-wedge trial of the toolkit developed for large-scale evaluation of impact on patient outcomes.

Abbott’s duiker Cephalophus spadix is a forest antelope endemic to a very few highland forests in Tanzania. Apparently extinct over much of its historical range, the species is listed as Endangered by the International Union for Conservation of Nature based on its rarity and its known current distribution in only 5 isolated upland areas: Kilimanjaro, Southern Highlands, West Usambara, Rubeho and Udzungwa Mountains. In contrast to the situation in the rest of its range, Abbott’s duiker is relatively well documented and locally abundant in parts of the Udzungwa Mountains, which may now be the only stronghold for the species. We review the distribution of Abbott’s duiker within the Udzungwa Mountains and present new information based on the non-invasive genetic identification of dung piles collected from the majority of forest blocks between 2006 and 2010 (73 confirmed dung samples). Our results include new records from outlying forest blocks where the presence of Abbott’s duiker was previously unknown. Moreover, we present the first population-level analysis of genetic structure and diversity in this endangered species based on nuclear microsatellites and mitochondrial sequence data. While these genetic results are limited due to small sample sizes, they indicate differentiation from other Abbott’s duiker populations, as well as low genetic diversity relative to sympatric antelope species. Finally, we discuss threats to Abbott’s duiker and identify broad trends within the differently managed Udzungwa Mountain forests, and elsewhere, that suggest potentially successful conservation strategies for this neglected species.

Background: There is a widely held assumption that research engagement improves health-care performance at various levels, but little direct empirical evidence. Objectives: To conduct a theoretically and empirically grounded synthesis to map and explore plausible mechanisms through which research engagement might improve health services performance. A review of the effects on patients of their health-care practitioner's or institution's participation in clinical trials was published after submission of the proposal for this review. It identified only 13 relevant papers and, overall, suggested that the evidence that research engagement improves health-care performance was less strong than some thought. We aimed to meet the need for a wider review. Methods: An hourglass review was developed, consisting of three stages: (1) a planning and mapping stage; (2) a focused review concentrating on the core question of whether or not research engagement improves health care; and (3) a wider (but less systematic) review of papers identified during the two earlier stages. Studies were included in the focused review if the concept of ‘engagement in research’ was an input and some measure of ‘performance’ an output. The search strategy covered the period 1990 to March 2012. MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and other relevant databases were searched. A total of 10,239 papers were identified through the database searches, and 159 from other sources. A further relevance and quality check on 473 papers was undertaken, and identified 33 papers for inclusion in the review. A standard meta-analysis was not possible on the heterogeneous mix of papers in the focused review. Therefore an explanatory matrix was developed to help characterise the circumstances in which research engagement might improve health-care performance and the mechanisms that might be at work, identifying two main dimensions along which to categorise the studies: the degree of intentionality and the scope of the impact. Results: Of the 33 papers in the focused review, 28 were positive (of which six were positive/mixed) in relation to the question of whether or not research engagement improves health-care performance. Five papers were negative (of which two were negative/mixed). Seven out of 28 positive papers reported some improvement in health outcomes. For the rest, the improved care took the form of improved processes of care. Nine positive papers were at a clinician level and 19 at an institutional level. The wider review demonstrated, for example, how collaborative and action research can encourage some progress along the pathway from research engagement towards improved health-care performance. There is also evidence that organisations in which the research function is fully integrated into the organisational structure out-perform other organisations that pay less formal heed to research and its outputs. The focused and wider reviews identified the diversity in the mechanisms through which research engagement might improve health care: there are many circumstances and mechanisms at work, more than one mechanism is often operative, and the evidence available for each one is limited. Limitations: To address the complexities of this evidence synthesis of research we needed to spend significant time mapping the literature, and narrowed the research question to make it feasible. We excluded many potentially relevant papers (though we partially addressed this by conducting a wider additional synthesis). Studies assessing the impact made on clinician behaviour by small, locally conducted pieces of research could be difficult to interpret without full knowledge of the context. Conclusions: Drawing on the focused and wider reviews, it is suggested that when clinicians and health-care organisations engage in research there is the likelihood of a positive impact on health-care performance. Organisations that have deliberately integrated the research function into organisational structures demonstrate how research engagement can, among other factors, contribute to improved health-care performance. Further explorations are required of research networks and schemes to promote the engagement of clinicians and managers in research. Detailed observational research focusing on research engagement within organisations would build up an understanding of mechanisms. Study registration: PROSPERO: CRD42012001990. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

Background: Nilotinib and dasatinib are now being considered as alternative treatments to imatinib as a first-line treatment of chronic myeloid leukaemia (CML). Objective: This technology assessment reviews the available evidence for the clinical effectiveness and cost-effectiveness of dasatinib, nilotinib and standard-dose imatinib for the first-line treatment of Philadelphia chromosome-positive CML. Data sources: Databases [including MEDLINE (Ovid), EMBASE, Current Controlled Trials, ClinicalTrials.gov, the US Food and Drug Administration website and the European Medicines Agency website] were searched from search end date of the last technology appraisal report on this topic in October 2002 to September 2011. Review methods: A systematic review of clinical effectiveness and cost-effectiveness studies; a review of surrogate relationships with survival; a review and critique of manufacturer submissions; and a model-based economic analysis. Results: Two clinical trials (dasatinib vs imatinib and nilotinib vs imatinib) were included in the effectiveness review. Survival was not significantly different for dasatinib or nilotinib compared with imatinib with the 24-month follow-up data available. The rates of complete cytogenetic response (CCyR) and major molecular response (MMR) were higher for patients receiving dasatinib than for those with imatinib for 12 months’ follow-up (CCyR 83% vs 72%, p