COVID Cholangiopathy Can Occur Despite Mild COVID

Introduction/Objective Post-COVID-19 cholangiopathy is a novel entity first noted in patients recovering from critical COVID-19 infection. Since its initial description in May 2021, all cases reported to date have been in patients with a history of critical COVID-19, defined as requiring ICU admission, the development of respiratory or circulatory failure requiring intubation or ECMO, or vasopressor support. Here we report three cases of post-COVID-19 cholangiopathy arising in patients who recovered from non-severe COVID-19. Methods/Case Report Six cases of COVID-19-related cholangiopathy were identified by retrospective review, three of which involved patients who verifiably did not develop critical COVID-19. Histology slides for each case were reviewed and all showed features of secondary sclerosing cholangitis. Patient 1 is a 41yo female who developed COVID-19 after liver transplant (LT). Despite administration of monoclonal antibodies, she required re-transplantation 6 weeks later. Explant histology showed bile infarcts, severe hepatocytic and canalicular cholestasis, ductular reaction, organizing portal vein thrombi, and necrotic bile ducts accompanied by bile lakes. Patient 2 is a 47yo male with alcoholic cirrhosis who was diagnosed with COVID-19 at the time of LT workup, and underwent LT 90 days later. In addition to alcohol-related cirrhosis, explant histology showed dilated bile ducts with periductal fibrosis, as well as severe ductular reaction with proliferating ductules containing thick, inspissated bile. Patient 3 is a 54yo male with history of LT for PSC who developed mild COVID-19 five years after LT. Allograft function subsequently worsened and biopsy 6 months later showed bile duct damage and loss of ~35% of bile ducts;repeat biopsy 14 months after his COVID diagnosis showed periportal fibrosis with edema, ductular reaction, marked hepatocellular and canalicular cholestasis, and ductopenia with loss of 60% bile ducts. Average time between COVID-19 diagnosis and onset of COVID-related cholangiopathy was 3 months (range: 6 weeks-6 months). These patients were also all immunocompromised with two due to prior LT and one being cirrhotic. Results (if a Case Study enter NA) NA. Conclusion Although previously reported only in patients with severe COVID-19, the cases described represent the first evidence that cholangiopathy, manifested by sclerosing cholangitis, can arise even in patients who were not critically ill, although this may require an immunocompromised state to develop.

Dual-Action Effect of Gallium and Silver Providing Osseointegration and Antibacterial Properties to Calcium Titanate Coatings on Porous Titanium Implants.

Previously, functional coatings on 3D-printed titanium implants were developed to improve their biointegration by separately incorporating Ga and Ag on the biomaterial surface. Now, a thermochemical treatment modification is proposed to study the effect of their simultaneous incorporation. Different concentrations of AgNO3 and Ga(NO3)3 are evaluated, and the obtained surfaces are completely characterized. Ion release, cytotoxicity, and bioactivity studies complement the characterization. The provided antibacterial effect of the surfaces is analyzed, and cell response is assessed by the study of SaOS-2 cell adhesion, proliferation, and differentiation. The Ti surface doping is confirmed by the formation of Ga-containing Ca titanates and nanoparticles of metallic Ag within the titanate coating. The surfaces generated with all combinations of AgNO3 and Ga(NO3)3 concentrations show bioactivity. The bacterial assay confirms a strong bactericidal impact achieved by the effect of both Ga and Ag present on the surface, especially for Pseudomonas aeruginosa, one of the main pathogens involved in orthopedic implant failures. SaOS-2 cells adhere and proliferate on the Ga/Ag-doped Ti surfaces, and the presence of gallium favors cell differentiation. The dual effect of both metallic agents doping the titanium surface provides bioactivity while protecting the biomaterial from the most frequent pathogens in implantology.

Evaluation of tixagevimab-cilgavimab in pre-exposure prophylaxis of COVID-19

Background and ImportanceIn the context of pre-exposure prophylaxis of COVID-19 in adults and adolescents aged 12 years and older (> 40 kg), tixagevimab-cilgavimab is currently included in clinical guidelines. The recommended dose is administered as two separate sequential intramuscular injections (150 mg of tixagevimab and 150 mg of cilgavimab), preferably in the gluteal muscles. Due to their recent authorisation, effectiveness and security of this treatment is not well known.Aim and ObjectivesThe aim of this study was to analyse the effectiveness and security of tixagevimab-cilgavimab in patients with COVID-19 risk after a complete vaccination regimen, collated with the data from PROVENT clinical trial.Material and MethodsRetrospective observational study in a cohort of COVID-19 risk patients. Electronic medical record and prescription application were used to collect the following data: sex, age, comorbidities, anticoagulation, and titles of anti-Spike antibodies, and COVID-19 infections after administration.ResultsThe study includes 41 patients (52.5% women, median age 64.5 years (SD 13.5)), who were candidates to prophylaxis because of their comorbidities: anti-CD20 active treatment (21), solid organ transplantation (renal (10) and pulmonary (14)), chronic kidney disease (2), immunosuppression (1), cytotoxic chemotherapy (1) or haematopoietic Stem Cell transplant (1). After the last vaccination, 97.5% of the patients had low antibodies (< 260 BAU/mL), which demonstrates an inadequate response to active immunisation. These comorbidities and clinical conditions were similar in PROVENT.In PROVENT, the duration of protection is estimated to be at least 6 months (0.2% COVID-19 positive cases after administration prior to day 183). In our study population, 3 patients were COVID-19 positive (7.5%) prior to day 90 after administration without severe or critical symptomatic illness.As with any other intramuscular injections, should be given with caution to patients with thrombocytopenia or coagulation disorders;5 patients were on anticoagulation therapy and no bleeding events were recorded. Therefore, non-hypersensitivity reactions have been observed.Conclusion and RelevanceEffectiveness and security of the pre-exposure prophylaxis with tixagevimab-cilgavimab was adequate in most of the patients treated, and similar to the data of the clinical trials. Even so, pre-exposure prophylaxis is not a substitute for vaccination. Nevertheless, further studies were necessary to establish the effective and security profile.References and/or AcknowledgementsConflict of InterestNo conflict of interest

Peri-implantitis and systemic inflammation: A critical update

Peri-implantitis is an inflammatory condition induced by bacterial biofilm that affects the soft and hard tissues surrounding dental implants, compromising the success of implant therapy. Recent studies have highlighted the potential links between peri-implant health and systemic inflammation, including uncontrolled diabetes mellitus, psychological stress, cardiovascular disease, obesity, and infectious diseases such as COVID-19. As an inflammatory disease, peri-implantitis may trigger systemic inflammation by elevating circulating levels of pro-inflammatory cytokines, which could have unknown impacts on overall health. While the relationship between periodontal health and systemic conditions is better understood, the association between peri-implant disease and systemic inflammation remains unclear. Therefore, this comprehensive review aims to summarize the most recent evidence on the relationship between peri-implantitis and systemic inflammation, focusing on biological complications, microbiology, and biomarkers. This review aims to enhance our understanding of the links between peri-implantitis and systemic inflammation and promote further research in this field by discussing the latest insights and clinical implications.

A Spectrum of Disease: Breast Implant-Associated Anaplastic Large Cell Lymphoma, Atypicals, and Other Implant Associations.

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.

Takayasu arteritis associated with autoimmune/inflammatory syndrome induced by adjuvants: a case-based review.

Takayasu's arteritis (TA) is a chronic granulomatous vasculitis that predominantly affects the aorta and its major branches. Despite advancements in the understanding of the pathogenic pathways of vascular inflammation, the etiology and predisposing factors of TA remain to be fully understood. In susceptible individuals, exposure to adjuvants may trigger, unlock or unmask an autoimmune disorder, presenting as non-specific constitutional symptoms or a fully developed autoimmune syndrome such as vasculitis. Here, we hypothesize that TA could be triggered by siliconosis, a subtype of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). ASIA, also known as Shoenfeld syndrome, encompasses a wide range of autoimmune and immune-mediated diseases resulting from dysregulation of the immune response after exposure to agents with adjuvant activity. This case report describes the development of large artery vasculitis, TA, in an individual one year following the placement of silicone breast implants. The patient initially presented with non-specific symptoms, and multiple imaging methods were employed, including ultrasound diagnostics, CT angiography, and 18-fluorodeoxyglucose positron emission tomography/CT. These techniques revealed vasculitic alterations in the carotid arteries and thoracic aorta. Initial treatment with glucocorticosteroids proved ineffective, prompting the addition of steroid-sparing immunosuppressive agents. Due to the distinct clinical symptoms, disease progression, implant-associated fibrosis, and resistance to therapy, the potential involvement of implants in the development of large-vessel vasculitis was considered, and a potential association with ASIA was postulated. Although there is limited evidence to support a direct link between adjuvants and the pathogenesis of TA, similarities in cellular immunity between the two conditions exist. The diagnosis of this complex and potentially debilitating condition requires a comprehensive clinical examination, laboratory evaluation, and instrumental assessment. This will aid in identifying potential contributing factors and ensuring successful treatment.

Characterization of the Oral Microbiome in Wearers of Fixed and Removable Implant or Non-Implant-Supported Prostheses in Healthy and Pathological Oral Conditions: A Narrative Review.

Oral commensal microorganisms perform very important functions such as contributing to the health of the host. However, the oral microbiota also plays an important role in the pathogenesis and development of various oral and systemic diseases. The oral microbiome may be characterized by a higher prevalence of some microorganisms than others in subjects with removable or fixed prostheses, depending on oral health conditions, the prosthetic materials used, and any pathological conditions brought about by inadequate prosthetic manufacturing or poor oral hygiene. Both biotic and abiotic surfaces of removable and fixed prostheses can be easily colonized by bacteria, fungi, and viruses, which can become potential pathogens. The oral hygiene of denture wearers is often inadequate, and this can promote oral dysbiosis and the switch of microorganisms from commensal to pathogens. In light of what emerged from this review, fixed and removable dental prostheses on teeth and on implants are subject to bacterial colonization and can contribute to the formation of bacterial plaque. It is of fundamental importance to carry out the daily hygiene procedures of prosthetic products, to design the prosthesis to facilitate the patient's home oral hygiene practices, and to use products against plaque accumulation or capable of reducing oral dysbiosis to improve patients' home oral practices. Therefore, this review primarily aimed to analyze the oral microbiome composition in fixed and removable implant or non-implant-supported prostheses wearers in healthy and pathological oral conditions. Secondly, this review aims to point out related periodontal self-care recommendations for oral dysbiosis prevention and periodontal health maintenance in fixed and removable implant or non-implant-supported prostheses wearers.

Patients who are candidates for treatment with monoclonal antibodies for pre-exposure prophylaxis of COVID-19

Background and ImportanceCilgavimab/tixagevimab are recombinant human IgG1ĸ monoclonal antibodies, which are indicated for COVID-19 pre-exposure prophylaxis in adults and adolescents ≥12 years of age weighing ≥40 kg.Aim and ObjectivesTo assess patients who are potential candidates for treatment with cilgavimab/tixagevimab in a tertiary care hospital and to describe the search strategy.Material and MethodsIn Spain, potential candidates for treatment with cilgavimab/tixagevimab are people with a high degree of immunosuppression (due to pathology or treatment) who do not respond adequately to vaccination. The Spanish Agency of Medicines and Health Products establishes the conditions for patients who are candidates for treatment with cilgavimab/tixagevimab1 . A search for patients was carried out, prioritising the following criteria: haematological patients on treatment with rituximab during the last 9 months, patients with solid organ transplant, patients with multiple sclerosis on treatment with ocrelizumab/rituximab, and patients with recent infection by COVID-19 who belong to any risk group. All of them underwent serology, including in the study those with negative serology (anti-anati-S antibodies < 260 BAU/ml). Those patients were scheduled for cilgavimab/tixagevimab administration.Results112 patients (38 = haematological patients on rituximab treatment, 50 = multiple sclerosis patients on rituximab/ocrelizumab treatment and 24 = kidney transplantation) were enrolled. 72 patients were included, 38 women (52.8%), median age 59.5 years old (27-77). The cause of exclusion was positive serology in all cases. 64 patients (88.9%) were on treatment with biologic immunomodulators (35 haematologic patients treated with rituximab <9 months, 27 patients with multiple sclerosis on treatment with rituximab/ocrelizumab/interferon beta-1A and 1 patient on treatment with adalimumab) and the rest were kidney transplant patients. Cilgavimab/tixagevimab was administered to 62 patients (86.1%), 7 patients with unknown reasons, 2 patients had COVID-19 infection and 1 patient had to be excluded for deep vein thrombosis due to the development of symptoms at the time of the appointment.Conclusion and RelevanceMore than half of the patients enrolled did not have an adequate response to COVID-19 vaccination. The search strategy was a good tool for administering pre-exposure prophylaxis of COVID-19 to these more vulnerable patients. Further studies are needed to evaluate the effectiveness of the treatment.References and/or Acknowledgements1. https://www.aemps.gob.es/la-aemps/ultima-informacion-de-la-aemps-acerca-del-covid%E2%80%9119/prevencion-frente-a-la-covid-19/personas-candidatas-a-recibir-evusheld-en-espana/#:~:text=En%20Espa%C3%B1a%2C%20son%20potenciales%20candidatas,responden%20adecuadamente%20a%20la%20vacunaci%C3%B3n.Conflict of InterestNo conflict of interest

Dental Implants And Orthodontics In Patients With Ectodermal Dysplasia: A Systemic Review

Ectodermal dysplasia is a hereditary disease that is associated with the involvement of organs with embryonic ectodermal structure such as teeth, nails, hair and sweat glands, lacrimal and salivary glands. The prevalence rate of this disease is 1 in every 100,000 people. The most common and severe form of ectodermal dysplasia is the X-linked hypo hidrotic type. The second common type of hidrotic ectodermal dysplasia is autosomal dominant, unlike the first type, sweat glands are not involved. Small and fragile nails, hyperkeratosis of the palms and feet, dry mouth, decreased tear production are some of the clinical symptoms of ectodermal dysplasia, which are the result of intolerance to heat. The facial features of the patient include a prominent forehead, sunken nose bridge, protruding ears, prominent lips, hypoplasia of the middle part of the face, and skin pigment around the eyes and mouth. Dental involvement is one of the most prominent features of ectodermal dysplasia, which can be seen in both primary and permanent tooth systems. Reduction in the number of teeth, delay in tooth growth, abnormal shape of anterior teeth in peg-shaped or conical form, smaller size of posterior teeth and enamel defects are observed. Alveolar ridge hypoplasia is also common due to the lack of teeth, followed by a decrease in the vertical height of the occlusion. A child with ectodermal dysplasia faces many problems in feeding, chewing, and speaking. Early treatment with dental prostheses can significantly reduce these problems.Copyright © 2023 Authors. All rights reserved.

UPSKILLING ONCOLOGY NURSES TO COMPETENCY WITH CAR-T INFUSION AND MANAGEMENT

The COVID-19 pandemic has forever changed the way we manage transplant patients. With the additional challenge of maintaining safety for transplant patients while accounting for COVID infections, there was a need to expand bed availability beyond the dedicated HSCT (Hematopoietic Stem Cell Transplant) Unit at New York Presbyterian: Weill-Cornell. Due to HEPA filtration and inability to change rooms to negative pressure, the dedicated HSCT unit, 10 West, is unable to accommodate COVID+ patients. The purpose of this initiative was to increase bed capacity and broaden oncology nurse knowledge by training them in administration and management of CAR-T patients. HSCT nurses identified the Autologous HSCT/Oncology unit, 10 North, as the target for this intervention due to the nurses' baseline transplant knowledge. 10 West nurses noted education gaps among 10 North nurses' knowledge of CAR-T using a 10-question electronic assessment. From January to March 2022, the team planned, coordinated, and executed multiple educational sessions for nurses and ancillary staff which were built on the previous autologous transplant education they had received in 2017. The first educational sessions were performed at multiple morning huddles. These focused on CAR-T management including education about chemotherapy, cell administration, patient monitoring post infusion, and emergencies. More in-depth educational sessions were offered in an hour-long lecture format. After these educational sessions were completed by 100% of the 10 North staff, we identified additional learning gaps and follow-up education was created and dispersed amongst the staff. Follow-up education was provided at regular monthly intervals. Upskilling the 10 North nursing team resulted in the successful administration of 10 CAR-T transplants in 2022. As of September 2022, the CAR-T program at New York Presbyterian has surpassed 2021 total CAR-T administrations, with 37 CAR-T transplants year-to-date.

ACIP Approves 2023 Child/Adolescent and Adult Immunization Schedules

The 2023 child/adolescent and adult immunization schedules have been approved by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) and are accessible at https://www.aafp.org/family-physician/patient-care/prevention-wellness/immunizations-vaccines.html. These schedules include links to COVID-19 vaccination information, vaccination information statements, adverse event reporting, and a QR code for online schedules. Notable changes include updates to COVID-19 recommendations and mpox (formerly monkeypox) vaccination.

E-Passport COVID-19 Adopting RFID Implants based on Microservices

COVID-19 has spread throughout the global and has restrained humans in all aspects of life including society, economy, education, etc. The first Corona virus appeared in China on 2019 and had mutated into several variants such as B.1.1.7 (Alpha), B.1.351 (Beta), E484Q (Delta), and BA.2 (Omicron). In order to block the virus to mutate and spread in the communities, we proposed a design of E-Passport by adopting RFID Implants with integrated Microservices technology. Our concepts is we design an android application (E-passport) that will be used by every institution on public places to stop the positive patients getting inside the public space to spread the virus. The checker in every public places need to scan the RFID implants on every humans hand by using NFC technology embedded on android phone with installed E-Passport to determine whether can enter or forbidden to enter. The RFID Implant stored a unique code that can be read as the reference of the person's data information stored in cloud database based on Microservices infrastructure. Our proposed design and architecture are dedicated to stop the COVID-19 virus to spread among public communities. © 2022 IEEE.

Smartphones as a Platform for Tourism Management Dynamics during Pandemics: A Case Study of the Shiraz Metropolis, Iran

During the past three years and with the spread of the pandemic, smartphones were the most important communication bridge between tourists and organizations;now more than ever, they are intertwined with the lives of tourists and destination management organizations. Although much research has been conducted in this field, the investigation of the effects of the pandemic on the technology and functionality of smartphones is one of the topics that has been less discussed. Therefore, the current research was conducted to determine the role of smartphones in tourism management dynamics during the pandemic. The research method was qualitative (content analysis, theme analysis), and 32 people participated in the interview process as a statistical sample. Then, the oral interviews were transcribed, and a thematic analysis was performed. For the analysis of the interviews, MAXQDA 2020 software was used. The results of the research indicate that smartphones were one of the most important platforms for tourism management dynamics during the pandemic, and in the event of a pandemic in the future, they can help contain the destruction to a great extent in their current position.

State of the Oral Implantology Practice in Spain during the COVID-19 Pandemic: A Cross-Sectional Survey.

At the beginning of the COVID-19 pandemic, strict measures of confinement and social distancing were taken. Dentists were considered essential personnel and their activity was restricted to emergency treatment. The present observational study aims to determine the situation of oral implantology practice in Spain during the initial period of the COVID-19 pandemic. This is a cross-sectional observational study based on the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. An electronic survey consisting of three blocks of questions was sent to all members of the Spanish Society of Implants. The data were analyzed using descriptive analysis. A total of 237 participants (14.3%) responded to the questionnaire. The majority of participants (60.8%) only attended emergencies during the first 9 months of the pandemic. Despite this, 77.2% reported having performed dental implant surgeries and 75.5% indicated that they performed non-essential treatments. The activity was fully recovered by 64.1% of the surveyed dentists. The majority of dentists (90.7%) considered that sufficient/adequate preventive measures were carried out at their workplace, which possibly contributed to the fact that 49.3% were not afraid of becoming infected. This concern was significantly and directly proportionally associated with the age of the surveyed dentists. The oral implant practice was affected to a greater extent during the first 9 months of the pandemic, especially in urban areas, with a greater impact on the workload of professionals with less specialised training in oral implantology.

A Brief Review on Covid-19 associated Mucormycosis

Risk factors include uncontrolled diabetes mellitus, especially ketoacidosis, steroid use, age, neutropenia Mucormycosis diagnosis involves a careful examination of clinical manifestations, magnetic resonance imaging modalities, early use of computed tomography (CT). No Types Route of transmission 1 Rhinocerebral (sinus and brain) Mucormycosis Inhalation of spores into the of spores into the paranasal sinuses and the invasion of blood vessels in the tissue 2 Pulmonary (lung) Mucormycosis Inhalation of infectious material 3 Gastrointestinal Mucormycosis The ingestion of contaminated food/ herbal medicine 4 Cutaneous (skin) Mucormycosis Skin infection by direct inoculation and in secondary form, by dissemination from other locations. 5 Disseminated Mucormycosis Blood stream Etiopathogenesis: The mucous membrane penetrates deep tissues, swallowing or inhaling spores and injecting them into the skin. Risk factors include uncontrolled diabetes mellitus, especially ketoacidosis, steroid use, age, neutropenia;Voriconazole, especially for the prevention of blood cancer, AIDS, renal failure, organ or stem cell transplantation, iron overload, skin trauma, broad-spectrum antibiotics, intravenous drug use, aspergillosis and malnutrition7,11 Mucormycosis can also occur in patients without overt immunodeficiency. According to statistics

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in 2023.

In 2011, a syndrome entitled ASIA (Autoimmune/inflammatory Syndrome Induced by Adjuvants; Shoenfeld's syndrome) was first described. ASIA aimed to organize under a single umbrella, the existing evidence regarding certain environmental factors which possess immune stimulatory properties, in order to shed light on a common pathway of autoimmune pathogenesis. Such environmental immune stimulators, or adjuvants, include among others: aluminum salts as in vaccines, various medical implants, as well as various infectious agents. After the launch of the ASIA syndrome, the expansion and recognition of this syndrome by different researchers from different countries began. During the past decades, evidence had been accumulating that (auto)immune symptoms can be triggered by exposure to environmental immune stimulatory factors that act as an adjuvant in genetically susceptible individuals. A panoply of unexplained subjective and autonomic-related symptoms has been reported in patients with ASIA syndrome. The current review summarizes and updates accumulated knowledge from the past decades, describing new adjuvants- (e.g. polypropylene meshes) and vaccine- (e.g. HPV and COVID vaccines) induced ASIA. Furthermore, a direct association between inflammatory/autoimmune diseases with ASIA syndrome, will be discussed. Recent cases will strengthen some of the criteria depicted in ASIA syndrome such as clear improvement of symptoms by the removal of adjuvants (e.g. silicone breast implants) from the body of patients. Finally, we will introduce additional factors to be included in the criteria for ASIA syndrome such as: (1) dysregulated non-classical autoantibodies directed against G-protein coupled receptors (GPCRs) of the autonomic nervous system and (2)) small fiber neuropathy (SFN), both of which might explain, at least in part, the development of 'dysautonomia' reported in many ASIA patients.

Application of Three-Dimensional Printers for Production of Personal Orbital Implants during Pandemics

Objective: The production of personalized prosthesis depends on human resources and involves a manufacturing process in which patients are involved individually in. As the world is experiencing the COVID-19 pandemic, less contact with the manufacturer is needed to stay safe. 3D printed prosthesis has reduced the need for human resource in the process, while allowing the patient to be completely removed from the design and manufacturing process. In this study an approach in which the patient is kept out of the manufacturing process was investigated. Material(s) and Method(s): The prosthesis model was created by using the image data obtained from the medical imaging devices. The outer part of the prosthesis was shaped with a developed image sampling system. The model was produced using three-dimensional printer. A cytotoxic analysis of the raw material used in the manufacturing process was performed. Result(s): The total production cost of the orbital implants was approximately about 8$. The cytotoxic analysis showed that layered manufacturing strategies could be used to develop implants and prostheses applicable to patients. Conclusion(s): COVID-19 underlined the importance of social distancing which is hard to apply during manufacturing of an eye prosthesis. The manual method results in an eye prosthesis which suits well after numerous trials. On the contrary, Digital Imaging and Communications in Medicine (DICOM) based eye prosthesis designation and manufacturing is not only rapid but also flawlessly fitting due to precise measurement during the manufacturing. Copyright © 2022, Nobelmedicus. All rights reserved.

Biodegradable biliopancreatic stents could help conserve health care resources during the COVID-19 pandemic: An observational multicenter study.

BACKGROUND: Considering limited resources for follow-up due to COVID-19, we used biodegradable stents (BPBS) for a range of biliopancreatic diseases. AIMS: This observational multicenter study aimed to evaluate technical safety and give first insights into clinical utility. METHODS: Technical success, clinical success, and necessity of follow-up visits for BPBS placed at three Austrian tertiary care hospitals between April 2020 and January 2021 were retrospectively analyzed. RESULTS: 63 stents were deployed in 60 patients. Main indications were prophylaxis of post-ERCP pancreatitis (PEP; n = 30/63; 48%) and bridging of prolonged waiting times to cholecystectomy (n = 21/63; 33%). Median time to surgery was 47 days (range: 136 days). The technical success rate was 94% (n = 59/63; 95% CI [0.84, 0.98]). Technical difficulties primarily arose with dislocations. Clinical success was achieved in 90% (n = 57/63; 95% CI [0.80, 0.96]). Clinical failure despite successful deployment was caused by papillary bleeding (1 patient) and cholestasis (1 patient). Both required reinterventions. No follow-up visits were needed in 97% of cases (n = 57/59; 95% CI [0.88, 1.00]). CONCLUSION: Biodegradable stents could help conserve health care resources without compromising treatment standards for PEP prophylaxis, which is particularly valuable in times of restricted resources. First insights into feasibility as bridging to cholecystectomy indicate a favorable safety profile.

Overcoming the post-processing barriers for 3D-printed medical models

Purpose>The purpose of this study is to identify, analyse and model the post-processing barriers of 3D-printed medical models (3DPMM) printed by fused deposition modelling to overcome these barriers for improved operational efficiency in the Indian context.Design/methodology/approach>The methodology used interpretive structural modelling (ISM), cross-impact matrix multiplication applied to classification (MICMAC) analysis and decision-making trial and evaluation laboratory (DEMATEL) to understand the hierarchical and contextual relations among the barriers of the post-processing.Findings>A total of 11 post-processing barriers were identified in this study using ISM, literature review and experts' input. The MICMAC analysis identified support material removal, surface finishing, cleaning, inspection and issues with quality consistency as significant driving barriers for post-processing. MICMAC also identified linkage barriers as well as dependent barriers. The ISM digraph model was developed using a final reachability matrix, which would help practitioners specifically tackle post-processing barriers. Further, the DEMATEL method allows practitioners to emphasize the causal effects of post-processing barriers and guides them in overcoming these barriers.Research limitations/implications>There may have been a few post-processing barriers that were overlooked by the Indian experts, which might have been important for other country's perspective.Practical implications>The presented ISM model and DEMATEL provide directions for operation managers in planning operational strategies for overcoming post-processing issues in the medical 3D-printing industry. Also, managers may formulate operational strategies based on the driving and dependence power of post-processing barriers as well as the causal effects relationships of the barriers.Originality/value>This study contributes to identifying, analyzing and modelling the post-processing barriers of 3DPMM through a combined ISM and DEMATEL methodology, which has not yet been reviewed. This study also contributes to decision makers developing suitable strategies to overcome the post-processing barriers for improved operational efficiency.