Genome-wide analysis in 756,646 individuals provides first genetic evidence that ACE2 expression influences COVID-19 risk and yields genetic risk scores predictive of severe disease.

SARS-CoV-2 enters host cells by binding angiotensin-converting enzyme 2 (ACE2). Through a genome-wide association study, we show that a rare variant (MAF = 0.3%, odds ratio 0.60, P=4.5×10-13) that down-regulates ACE2 expression reduces risk of COVID-19 disease, providing human genetics support for the hypothesis that ACE2 levels influence COVID-19 risk. Further, we show that common genetic variants define a risk score that predicts severe disease among COVID-19 cases.

Calibration of the modified Huddart and Bodenham scoring system against the GOSLON/5-year-olds' index for unilateral cleft lip and palate.

The GOSLON/5-year-old scoring systems have been used in various national and international studies. This study aims to identify the range of Modified Huddart and Bodenham (MHB) scores, which correlate with each GOSLON and 5-year-old category and thereby create a new scoring system that allows comparison with historical data. Two hundred and eighty-three unilateral cleft lip and palate study models from England and Scotland that had all been previously scored using the 5-year-old and GOSLON indices by calibrated examiners were scored using MHB on two separate occasions a month apart by two examiners. Reliability analysis using intraclass correlation and Bland Altman plots were performed. Ordinal regression was used to define the categories of MHB that correspond to the 5-year-old and GOSLON categories. The results revealed a high level of repeatability for both the 5 and the 10 year old models. The MHB scale was grouped into the five categories of the GOSLON and 5-year-old indices with more precision for the 5 year than the 10 year scores. In conclusion, there was high intra-examiner and inter-examiner agreement using the MHB scoring system. It also correlates well with the 5-year-old and GOSLON indices and has been shown to be a much more sensitive scoring system.

Reliability of the Kindelan scoring system for alveolar bone grafting with and without a pre-graft occlusal radiograph in patients with cleft lip and palate.

We aimed to compare the reliability of the Kindelan system using one postoperative radiograph to assess the success of alveolar bone grafts with the use of two occlusal radiographs (before and after operation). This retrospective reliability study took place at Glasgow Dental Hospital cleft unit, and two examiners scored 84 radiographs two weeks apart. The sample was taken from a database of patients having alveolar bone grafts between 2007 and 2010. They had an upper anterior occlusal radiograph taken before the graft and another at a mean of 6 months (range 3-12 months) postoperatively. Kappa scores were used to measure intraobserver and interobserver agreement. Intraexaminer agreement ranged from good to very good using one or two radiographs, and interexaminer agreement ranged from moderate to good for both systems. Reliability when scoring with either one or two radiographs was similar, and ranged from good to very good.

Slow-release fluoride devices for the control of dental decay.

BACKGROUND: Slow-release fluoride devices have been investigated as a potentially cost-effective method of reducing dental caries in those with high risk of disease. OBJECTIVES: To evaluate the effectiveness of different types of slow-release fluoride devices on preventing, arresting, or reversing the progression of carious lesions on all surface types of deciduous and permanent teeth. SEARCH STRATEGY: We searched (up until February 2005) multiple electronic databases (Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE), bibliographic references of identified randomised controlled trials (RCTs), textbooks, review articles, and meta-analyses. Letters were sent to authors of identified RCTs asking for clarifications and unpublished or ongoing research. Relevant journals were handsearched for more recent reports than those obtained from databases. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials (RCTs) comparing slow-release fluoride devices with an alternative fluoride treatment, placebo, or no intervention in all age groups. The main outcomes measures sought were changes in numbers of decayed, missing, and filled teeth or surfaces (DMFT/DMFS in permanent teeth or dmft/dmfs in primary teeth) and progression of carious lesions through enamel and into dentine. DATA COLLECTION AND ANALYSIS: Abstracts of all reports identified were considered independently by two review authors and full reports obtained of any potentially relevant articles to allow further assessment for relevance and validity. Data extraction and quality assessment were conducted independently by two and three review authors respectively, with arbitration by the fourth. Where uncertainty existed, authors were contacted for additional information. MAIN RESULTS: Only one trial involving 174 children fully met the criteria for inclusion in this review. Although 132 children were still included in the trial at the 2-year completion point, examination and statistical analysis was performed on only the 63 children who had retained the beads. Thirty-one of these were in the intervention group and 32 in the control group. Amongst these 63 children, caries increment was reported to be statistically significantly lower in the intervention group than in the placebo group (mean difference: -0.72 DMFT, 95% confidence interval -1.23 to -0.21 and -1.52 DMFS, 95% confidence interval -2.68 to -0.36) AUTHORS' CONCLUSIONS: There is some evidence of a caries-inhibiting effect of slow-release fluoride glass beads. This evidence is regarded as weak and unreliable because the results were from participants selected on the basis of bead retention rather than an intention-to-treat analysis.

Malignant (invasive) otitis externa involving the temporomandibular joint.

Malignant (invasive) otitis externa (MOE) is an infection involving the external auditory meatus (EAM), most often found in elderly diabetics, which carries a high morbidity and mortality. In advanced cases it may give rise to osteomyelitis and cranial neuropathies. This is a case ofMOE, which invaded the posterior wall of the right temporomandibular joint (TMJ), resulting in severe trismus and pain. Subsequently, this required treatment by replacement of the glenoid fossa with a Silastic prosthesis.