Safety and efficacy of extended versus standard interval dosing of natalizumab in multiple sclerosis patients: a systematic review and meta-analysis.

BACKGROUND: Multiple sclerosis (MS) is a chronic inflammatory, immune-mediated disease affecting the central nervous system. Natalizumab, an FDA-approved monoclonal antibody for MS, has been explored for its off-label extended interval dosing (EID), suggesting a potential reduction in the risk of progressive multifocal leukoencephalopathy (PML) compared to standard interval dosing (SID). Our objective was to assess the efficacy and safety of EID in comparison to SID for natalizumab treatment in patients with MS. METHODS: We searched PubMed, Embase, WOS, Scopus, Ovid, Science Direct, Clinical trials.gov, and Cochrane Library. Our assessed outcomes were clinical relapses, MRI activity, change in expanded disability status scale [EDSS], and the risk of PML. The EID group was defined as 5 to 8 weeks [EID (Q5-8W)]. The analysis was conducted using RevMan ver. 5.4. The effect estimates were presented as a risk ratio [RR] or mean difference with 95% confidence intervals [CI] using SID group as the reference for comparisons. RESULTS: Fourteen studies met our inclusion criteria: 2 RCTs, 1 switched single-arm trial, and 12 observational studies. No significant differences were found in all efficacy outcomes of interest. Risk of clinical relapses [RR = 0.90, (95%CI 0.80, 1.02)], risk of new or newly enlarging T2 hyperintense MRI lesions [RR = 0.78, (95%CI 0.59, 1.04)], risk gadolinium enhancing lesions [RR = 1.30, (95%CI 0.98, 1.72)], change in EDSS [MD = 0.09 (95%CI - 0.57, 0.76)], risk of PML [RR = 1.09, 95%CI (0.24, 4.94)]. CONCLUSION: In summary, our meta-analysis indicates that natalizumab maintains its effectiveness under extended interval dosing [up to 8 weeks], presenting comparable risks for clinical relapses, MRI lesions, EDSS, and PML. Caution is advised given study limitations and heterogeneity. Robust conclusions necessitate well-designed high-quality prospective studies.

Herpes simplex virus infection and the risk of dementia: a systematic review and meta-analysis.

Aim: The authors aimed to perform a meta-analysis to evaluate the association between herpes simplex virus (HSV) infection and the risk of developing dementia. Methods: The authors searched the following databases: PubMed, Scopus, Cochrane Library, and Web of Science. The authors included any randomized control trials and controlled observational studies that investigated the prevalence of dementia in HSV-infected patients and HSV-free control group. Also, if the studies measured the levels of HSV antibodies and incidence of these antibodies in patients with dementia compared with a healthy control group. Results: After a comprehensive literature search, 19 studies were included in the meta-analysis with 342 535 patients included in the analysis. The pooled analysis showed a statistically significant association between Alzheimer's disease (AD), mild cognitive impairment (MCI), and increased levels of IgG titer group [mean difference (MD) = 0.99, 95% confidence interval (CI) = 0.36-1.63, P-value = 0.002], (MD = 0.80, 95% CI = 0.26-1.35, P-value = 0.004), respectively. Additionally, the generic inverse variance showed a statistically significant association between the HSV group and increased incidence of dementia compared with the no HSV control group [risk ratio (RR) = 2.23, 95% CI = 1.18-2.29, P-value <0.00001]. Moreover, this analysis showed no statistically significant difference between the AD group and the control group in anti-HSV IgM titer n (%) outcome (RR = 1.35, 95% CI = 0.91-2.01, P-value = 0.14), respectively. Conclusion: This study revealed that AD and MCI patients have increased levels of IgG antibodies titer against HSV infection. The study showed a significant association between HSV infection and increased incidence of dementia. Thus, regular follow-up of HSV patients' IgG titer levels could be useful in the prevention of dementia in these patients.

The impact of target speed on pedestrian, bike, and speeding crash frequencies.

This research aims to investigate the influence of adopting the target speed concept on different types of crashes including pedestrian, bike, and speeding-related crashes. The Target speed is the highest speed that vehicles should operate on a roadway segment in a specific context. Based on the reviewed literature, this is the first study to investigate the relationship between target speed and crash frequency. Hence, big data including probe-vehicle data, traffic characteristics, geometric features, and land use attributes were utilized to develop crash prediction models. The main contributions of this research are to quantify the impacts of target speed on traffic safety considering context categories and to conclude the potential recommendations to lower different types of crashes. The 85th percentile speed was calculated and utilized in the developed models. Three crash prediction models were developed for pedestrian, bike, and speeding-related crashes. They were used in the analysis to quantify the impact of adopting target speed on different crash types. The results showed a significant reduction in the three crash types when using the target speed. Most of the improvements took place in three context categories: C3C: Suburban Commercial Segments, C3R: Suburban Residential Segments, and C4: Urban General Segments. Hence, this research recommends adopting target speed specifically in urban and suburban areas. Further, it suggests considering some measures to lower vulnerable road users' and speeding-related crashes. Following the recommendations of this research would help to reduce different types of crash frequency, hence, improving the mobility and safety for all users in different context classifications.

Multi-vehicle safety functions for freeway weaving segments using lane-level traffic data.

This study develops Safety Performance Functions (SPFs) for freeway weaving segments. Due to the coexistence of three different movements including through, merging, and divering traffic, the probability of crashes in weaving segments is higher compared to other segment types. Further, the traffic flow in this section is the most unstable. Hence, to analyze detailed traffic conditions, this study utilized lane-level traffic data. The SPFs were developed using the Poisson Lognormal (PLN) regression model technique. The results showed that different traffic parameters were significant based on the types of crashes. For the rear-end crashes model, more general traffic conditions of the weaving segment were found to be significantly associated with the crash frequency such as the natural logarithm of average speed of through lanes. Nevertheless, for the sideswipe and angle crashes models, the traffic variables which are directly related to the weaving movements were selected as significant factors such as the off-ramp volume ratio, and standard deviation of speed of the rightmost lane. The results presented in this study can be meaningful in that they can serve as a basis for the weaving segments related safety evaluation studies. In addition, the developed models' results can be a great source to establish operational strategies to improve traffic safety on freeway weaving segments.

Time-specific hierarchical models for predicting crash frequency of reversible and high-occupancy vehicle lanes.

Time-specific Safety Performance Functions (SPFs) were proposed to achieve accurate and dynamic crash frequency predictions. This study contributes to the literature by developing time-specific SPFs for freeways that include reversible lanes (RL) and freeways that include High-Occupancy Vehicle lanes (HOV) using Microwave Vehicle Detection System (MVDS) data from Virginia, Arizona and Washington States. Variables that capture the time-specific traffic turbulence were prepared and considered in the developed SPFs. Moreover, two different hierarchical models were proposed to identify factors associated with the different crash types or severity in crash frequency prediction. The results indicated that the variables representing the volume difference between reversible and general-purpose lanes (GPL) were positively associated with crash frequency. Further, the variable that indicated the design of the access point of the reversible lane was positively associated with crash frequency. The models comparison results showed that the hierarchical models outperformed the corresponding Poisson lognormal model with lower AIC and MAE values. This study also tested the proposed hierarchical models on High-Occupancy Vehicle freeway sections and reached the same conclusion on model comparison results. The significant variables representing the logarithm of volume were found to be significant and positive with crash frequency. Moreover, the difference in average speed between the HOV lanes and GPL was also found to be positive and significant with the crash frequency. In general, this study successfully identified the factors associated with the different crash types or severity in crash frequency prediction models.

A multi-country study on the impact of sex and age on oral features of COVID-19 infection in adolescents and young adults.

BACKGROUND: Oral diseases are features of COVID-19 infection. There is, however, little known about oral diseases associated with COVID-19 in adolescents and young adults (AYA). Therefore, the aim of this study was to assess oral lesions' association with COVID-19 infection in AYA; and to identify if sex and age will modify these associations. METHODOLOGY: Data was collected for this cross-sectional study between August 2020 and January 2021 from 11-to-23 years old participants in 43-countries using an electronic validated questionnaire developed in five languages. Data collected included information on the dependent variables (the presence of oral conditions- gingival inflammation, dry mouth, change in taste and oral ulcers), independent variable (COVID-19 infection) and confounders (age, sex, history of medical problems and parents' educational level). Multilevel binary logistic regression was used for analysis. RESULTS: Complete data were available for 7164 AYA, with 7.5% reporting a history of COVID-19 infection. A significantly higher percentage of participants with a history of COVID-19 infection than those without COVID-19 infection reported having dry mouth (10.6% vs 7.3%, AOR = 1.31) and taste changes (11.1% vs 2.7%, AOR = 4.11). There was a significant effect modification in the association between COVID-19 infection and the presence of dry mouth and change in taste by age and sex (P = 0.02 and < 0.001). CONCLUSION: COVID-19 infection was associated with dry mouth and change in taste among AYA and the strength of this association differed by age and sex. These oral conditions may help serve as an index for suspicion of COVID-19 infection in AYA.

Anxiety among Adolescents and Young Adults during COVID-19 Pandemic: A Multi-Country Survey.

(1) Background: Adolescents-and-young-adults (AYA) are prone to anxiety. This study assessed AYA's level of anxiety during the COVID-19 pandemic; and determined if anxiety levels were associated with country-income and region, socio-demographic profile and medical history of individuals. (2) Methods: A survey collected data from participants in 25 countries. Dependent-variables included general-anxiety level, and independent-variables included medical problems, COVID-19 infection, age, sex, education, and country-income-level and region. A multilevel-multinomial-logistic regression analysis was conducted to determine the association between dependent, and independent-variables. (3) Results: Of the 6989 respondents, 2964 (42.4%) had normal-anxiety, and 2621 (37.5%), 900 (12.9%) and 504 (7.2%) had mild, moderate and severe-anxiety, respectively. Participants from the African region (AFR) had lower odds of mild, moderate and severe than normal-anxiety compared to those from the Eastern-Mediterranean-region (EMR). Also, participants from lower-middle-income-countries (LMICs) had higher odds of mild and moderate than normal-anxiety compared to those from low-income-countries (LICs). Females, older-adolescents, with medical-problems, suspected-but-not-tested-for-COVID-19, and those with friends/family-infected with COVID-19 had significantly greater odds of different anxiety-levels. (4) Conclusions: One-in-five AYA had moderate to severe-anxiety during the COVID-19-pandemic. There were differences in anxiety-levels among AYAs by region and income-level, emphasizing the need for targeted public health interventions based on nationally-identified priorities.

Cigarettes' use and capabilities-opportunities-motivation-for-behavior model: a multi-country survey of adolescents and young adults.

The use of cigarettes among adolescents and young adults (AYA) is an important issue. This study assessed the association between regular and electronic-cigarettes use among AYA and factors of the Capability-Motivation-Opportunity-for-Behavior-change (COM-B) model. A multi-country survey was conducted between August-2020 and January-2021, Data was collected using the Global-Youth-Tobacco-Survey and Generalized-Anxiety-Disorder-7-item-scale. Multi-level logistic-regression-models were used. Use of regular and electronic-cigarettes were dependent variables. The explanatory variables were capability-factors (COVID-19 status, general anxiety), motivation-factors (attitude score) and opportunity-factors (country-level affordability scores, tobacco promotion-bans, and smoke free-zones) controlling for age and sex. Responses of 6,989-participants from 25-countries were used. Those who reported that they were infected with COVID-19 had significantly higher odds of electronic-cigarettes use (AOR = 1.81, P = 0.02). Normal or mild levels of general anxiety and negative attitudes toward smoking were associated with significantly lower odds of using regular-cigarettes (AOR = 0.34, 0.52, and 0.75, P < 0.001) and electronic-cigarettes (AOR = 0.28, 0.45, and 0.78, P < 0.001). Higher affordability-score was associated with lower odds of using electronic-cigarettes (AOR = 0.90, P = 0.004). Country-level-smoking-control policies and regulations need to focus on reducing cigarette affordability. Capability, motivation and opportunity factors of the COM-B model were associated with using regular or electronic cigarettes.

Oral manifestations in young adults infected with COVID-19 and impact of smoking: a multi-country cross-sectional study.

Background: Oral manifestations and lesions could adversely impact the quality of people's lives. COVID-19 infection may interact with smoking and the impact on oral manifestations is yet to be discovered. Objectives: The aim of this study was to assess the self-reported presence of oral lesions by COVID-19-infected young adults and the differences in the association between oral lesions and COVID-19 infection in smokers and non-smokers. Methods: This cross-sectional multi-country study recruited 18-to-23-year-old adults. A validated questionnaire was used to collect data on COVID-19-infection status, smoking and the presence of oral lesions (dry mouth, change in taste, and others) using an online platform. Multi-level logistic regression was used to assess the associations between the oral lesions and COVID-19 infection; the modifying effect of smoking on the associations. Results: Data was available from 5,342 respondents from 43 countries. Of these, 8.1% reported COVID-19-infection, 42.7% had oral manifestations and 12.3% were smokers. A significantly greater percentage of participants with COVID-19-infection reported dry mouth and change in taste than non-infected participants. Dry mouth (AOR=, 9=xxx) and changed taste (AOR=, 9=xxx) were associated with COVID-19- infection. The association between COVID-19-infection and dry mouth was stronger among smokers than non-smokers (AOR = 1.26 and 1.03, p = 0.09) while the association with change in taste was stronger among non-smokers (AOR = 1.22 and 1.13, p = 0.86). Conclusion: Dry mouth and changed taste may be used as an indicator for COVID-19 infection in low COVID-19-testing environments. Smoking may modify the association between some oral lesions and COVID-19-infection.

Does ramadan fasting affect the therapeutic and clinical outcomes of warfarin? a systematic review and meta-analysis.

BACKGROUND: Warfarin's therapeutic effect is affected by many factors, including diet modifications. The impact of Ramadan fasting on warfarin is controversial. The aim of this systematic review and meta-analysis was to investigate the effect of Ramadan fasting on patients taking warfarin. METHODS: A literature search was done in PubMed, WOS, Scopus, and Embase from inception to May 24, 2021. All relevant studies measuring the international normalized ratio (INR), time in therapeutic range (TTR), or the number of patients within therapeutic range before, during, and after Ramadan were assessed by full-text screening for achieving all of the inclusion criteria. We used the Newcastle-Ottawa Scale for quality assessment and RevMan 5.4 software for meta-analysis. RESULTS: A total of five studies with 446 patients were included in the meta-analysis. The patients served as their own control. Our pooled analyses showed no significant difference during Ramadan compared to pre-Ramadan (MD: 0.08; 95% CI: - 0.00, 0.15; P = 0.06) and post-Ramadan (MD: - 0.00; 95% CI: - 0.14, 0.14; P = 1.00, respectively). There was only a significant increase in the risk ratio of supratherapeutic INR when comparing post-Ramadan vs. pre-Ramadan (RR: 1.69; 95% CI: 1.22, 2.33; P = 0.001). However, there was no significant risk for supratherapeutic INR during Ramadan compared to pre-Ramadan or post-Ramadan; the number of patients within the therapeutic range of INR during Ramadan compared to pre-Ramadan; and TTR during Ramadan, pre-Ramadan, and post-Ramadan. CONCLUSION: Ramadan fasting did not affect INR level, TTR, or the number of patients within the therapeutic range before, during, and after Ramadan. However, there was a possibility of achieving a supratherapeutic INR post-Ramadan compared to pre-Ramadan. Therefore, INR monitoring and warfarin dose adjustments accordingly are recommended after Ramadan.

Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass to Enhance Weight Loss: Single Enterprise Mid-Term Outcomes and Literature Review.

Background: Suboptimal weight loss (SWL) occurs up to 30% after sleeve gastrectomy (SG). Conversion to Roux-en-Y gastric bypass (cRYGB) has shown heterogeneous results in terms of additional weight loss and resolution of weight-related comorbidities. We aim to evaluate mid-term outcomes of cRYGB specifically for SWL after SG. Methods: All patients who underwent cRYGB for SWL from April 2010 to June 2019 from prospective registries at three affiliated tertiary care centers were retrospectively reviewed. Patients who underwent revision or conversion for complications were excluded. Mixed-effects and polynomial regression models were used to evaluate weight loss results after conversion. Results: Thirty-two patients underwent cRYGB from SG. About 68.7% were women with mean age of 46.6 years. Mean body mass index (BMI) before SG was 55.3 kg/m2. Before conversion, mean BMI was 44.5 kg/m2 with 17.3% total weight loss (TWL). All procedures were completed laparoscopically in a median surgical time of 183 min. Three major complications occurred (9.3%), one gastrojejunal (GJ) leak and two reoperations. Four cases (12.5%) of GJ stenosis were diagnosed. No mortality was registered. Mean follow-up time was 24 months and patients had 36 kg/m2 mean BMI, 17.4% TWL, 27.2% had BMI >35 kg/m2. Conclusions: cRYGB after SG for SWL showed good mid-term results, better than those reported in literature.

Developing a grouped random parameter beta model to analyze drivers' speeding behavior on urban and suburban arterials with probe speed data.

Speeding is one of the major contributing factors to traffic fatalities. Various speed management strategies have been proposed to encourage drivers to select more appropriate speeds. This study aims to explore the different effects of the speed management strategies on the speeding proportions at urban and suburban arterials. Probe speed data was used to calculate the speeding proportions. To overcome the variability of probe speed data caused by the signalized intersections, a new method was suggested to calculate the speeding proportion, and a fractional split model was estimated to adjust the probe speed data. A Beta regression model was developed to analyze the speeding proportion. A grouped random parameter modeling structure was adopted to realize the different effects of speed management strategies and other road attributes on speeding proportions by different road types. Besides, a fixed beta model was developed for the comparison. The results suggested the grouped random parameter model could provide better performance over the counterpart and could realize the different effects of road features and other contributing factors on the speeding of different roads. It is expected that the findings could help inform more appropriate road design in order to reduce speed limit violations on urban and suburban arterials.

Vulnerable road users' crash hotspot identification on multi-lane arterial roads using estimated exposure and considering context classification.

This research develops safety performance functions and identifies the crash hotspots based on estimated vulnerable road users' exposure at intersections and along the roadway segments. The study utilized big data including Automated Traffic Signal Performance Measures (ATSPM) data, crowdsourced data (Strava), Closed Circuit Television (CCTV) surveillance camera videos, crash data, traffic information, roadway features, land use attributes, and socio-demographic characteristics. It comprises an extensive comparison between a wide array of statistical and machine learning models that were developed to estimate pedestrian and bike exposure. The results indicated that the XGBoost approach was the best to estimate vulnerable road users' exposure at intersections as well as bike exposure along the roadway segments. Afterwards, the estimated exposure was utilized as input variables to develop crash prediction models that relate different crash types to potential explanatory variables. Negative Binomial approach was followed to develop crash prediction models to be consistent with the Highway Safety Manual. The results show that the exposure variables (i.e., AADT, bike exposure, and the interaction between them) have significant influences on the two types of crashes (i.e., crashes of vulnerable road users at intersections and bike crashes along the segments). Further, the results indicated that the context classification is significantly related to crashes. Based on the developed models, the PSIs were calculated and the hotspots were identified for the two crash types. It was found that hotspots were more likely to be located near the city of Orlando. Coastal roadways were classified as cold categories regarding bike crashes. Further, C4 roadway segments were found to be significantly related to the increase of vulnerable road users' crashes at intersections and bike crashes along the segments.

Effect of foam and liquid bleomycin in the management of venous malformations in head and neck region: A comparative study.

BACKGROUND: Many treatment options for venous malformations (VMs) have been documented in the literature, but injection sclerotherapy has been considered a current mainstay for their treatment. We conducted this study to determine the efficacy and durability of injection of different forms of bleomycin sclerotherapy in the treatment of VMs in the cervico-facial region. PATIENTS AND METHODS: Thirty patients with clinically diagnosed VMs of the head and neck region, confirmed by magnetic resonance imaging, had been injected with the bleomycin sclerosing material. They were divided into 2 groups according to the form of bleomycin injected: in Group A, the foam form was injected, and in Group B, the liquid form was injected. Data of patients' demographics, anatomical sites, type and volume of the VMs, number of injection sessions and the average dose of injected agents were documented and statistically compared between the 2 groups. RESULTS: MRI showed a decline of more than 90% from the initial size of the lesions in 66.7% of the cases and considerable decline (60-90%) in 33.3% of the cases. In Group A, the number of sessions and the amount of sclerosant material injected were lower than those in Group B. The cumulative dose in the equal-sized lesions was lower in the foam form than in the liquid form. CONCLUSION: We recommend using bleomycin in its foam form on a greater number of patients with larger VMs and in different sites, as the results are more promising in this form than in the liquid form.

Association of vitamin D receptor gene polymorphisms with breast cancer risk in an Egyptian population.

This study aimed to explore whether genetic polymorphisms in vitamin D receptor are correlated to the breast cancer prevalence in an Egyptian population. Polymerase chain reaction-restriction fragment polymorphism was used to genotype three frequently analyzed vitamin D receptor gene single-nucleotide polymorphisms (rs1544410, rs7975232, and rs731236) and were identified by sequencing analysis. This is the first study that recorded a new single-nucleotide polymorphism in ApaI genotype within an Egyptian population and was registered with the accession number KY859868. The authors found that TC in rs731236, and TG in KY859868 single-nucleotide polymorphism showed significant distribution differences with an increased risk of breast cancer ( p < 0.05, odds ratio = 3.71, 95% confidence interval: 1.04-13.28 and p < 0.001, odds ratio = 7.05, 95% confidence interval: 2.02-24, respectively) compared with the wild-type TT genotype carriers in both single-nucleotide polymorphisms. In addition, the distribution frequencies of haplotypes ACT, GTT, and ATT in the patients group were significant, where ATT haplotype was associated with the highest breast cancer risk among all other haplotypes in the patients group ( p = 0.0023, odds ratio = 1.72, 95% confidence interval: 1.24-2.437). In conclusion, vitamin D receptors ApaI and TaqI confer high breast cancer susceptibility, particularly in Egyptians females carrying haplotype ATT. However, further studies focusing on the vitamin D receptor variants and haplotypes effects on vitamin D and vitamin D receptor concentrations, activities, and functionalities are needed.

Reconstruction of post-traumatic full-thickness defects of the upper one-third of the auricle.

BACKGROUND: Reconstruction of partial ear defects represents a difficult challenge to the plastic surgeon due to the delicate and intricate architecture of the chondrocutaneous sandwich of the external ear. METHODS: Fourteen patients with acute or previous traumatic subtotal loss of the upper one-third of the auricle were treated with autologous contralateral conchal cartilage graft and superficial temporoparietal fascia flaps. RESULTS: The symmetry of the reconstructed ears was satisfactory and the cosmetic appearance was acceptable for 13 patients. Minor hematoma at the conchal cartilage graft donor site occurred in one (7.1%) patient and marginal loss of temporoparietal flap in another (7.1%). Revision surgery was required for widening of the scar and obscuring of the upper pole contour in one (7.1%) patient. No additional complications were encountered. CONCLUSION: The authors recommend using this combined technique for reconstruction of full-thickness auricular defects.

HISTORIQUE: La reconstruction d'anomalies partielles de l'oreille pose un défi particulier au chirurgien plasticien en raison de l'architecture délicate et complexe du bourgeonnement chondrocutané de l'oreille externe. MÉTHODOLOGIE: Quatorze patients ayant subi une perte traumatique subtotale aiguë ou antérieure du tiers supérieur de l'oreille se sont fait traiter par une greffe du cartilage de la conque controlatérale autologue et des lambeaux superficiels de fascia temporopariétal. RÉSULTATS: Treize patients ont trouvé la symétrie de l'oreille reconstruite satisfaisante et leur aspect esthétique acceptable. Un patient (7,1 %) a présenté un hématome mineur au foyer de la greffe de cartilage de la conque et un autre (7,1 %), une perte marginale du lambeau temporopariétal. Un patient (7,1 %) a dû subir une opération de reprise pour élargir la cicatrice et occulter le contour du pôle supérieur. Aucune autre complication ne s'est produite. CONCLUSION: Les auteurs recommandent cette technique combinée pour la reconstruction des anomalies de toute l'épaisseur de l'oreille.

Incidence, etiology, and patterns of maxillofacial fractures in ain-shams university, cairo, egypt: a 4-year retrospective study.

Although there is a worldwide increase in maxillofacial trauma incidence; the pattern and etiology of these injuries varies from one country to another depending on socioeconomic, cultural, and environmental factors. This study aims to realize the epidemiological characteristics of maxillofacial fractures in our department. A retrospective cross-sectional study of all facial trauma patients admitted to our department during 2009 to 2012. Patients' data including gender, age, etiology of trauma, the pattern and demographic distribution of fractures of maxillofacial skeleton, and associated injuries were analyzed and compared with previously published data. The chi-square test was used with a p value of less than 0.05, which was considered statistically significant. There is a significant increase in maxillofacial fractures incidence in the past 2 years than former ones. There is a male predominance with highest incidence in the age group of 20 to 40 years. Road traffic accident is the most common etiological factor followed by violence. There is increase in mandibular fracture incidence compared with midface. The significant increased incidence of maxillofacial fracture due to motor car accidents and assaults in the past 2 years reflects a behavioral change within the community.

Fibrin sealant and lipoabdominoplasty in obese grade 1 and 2 patients.

BACKGROUND: Ever since lipoabdominoplasty was first developed to achieve better aesthetic outcomes and less morbidity, the rate of seroma formation, especially in obese patients, has disturbed plastic surgeons. The aim of this study was to evaluate the effect of fibrin sealant in the prevention of seroma formation after lipoabdominoplasty in obese patients. METHODS: Sixty patients with a body mass index (BMI) between 30 and 39.9 were assigned randomly to 1 of 2 groups (30 patients each). Group A underwent lipoabdominoplasty with fibrin glue, while group B underwent traditional lipoabdominoplasty; both had closed suction drainage applied to the abdomen. The patients' demographics and postoperative complications were recorded. Seroma was detected using abdominal ultrasound examinations at two postoperative periods: between postoperative days 10 and 12 and, between postoperative days 18 and 21. RESULTS: The age range was 31 to 55 years (38.5±9.5 years) in group A and 25 to 58 years (37.8±9.1 years) in group B, while the mean BMI was 31.4 to 39.9 kg/m(2) (32.6 kg/m(2)) in group A and 32.7 to 37.4 kg/m(2) (31.5 kg/m(2)) in group B. In group A, the patients had a complication rate of 10% in group A versus 43% in group B (P<0.05). The incidence of seroma formation was 3% in the fibrin glue group but 37% in the lipoabdominoplasty-alone group (P<0.05). CONCLUSIONS: Lipoabdominoplasty with the use of autologous fibrin sealant is a very effective method that significantly reduces the rate of postoperative seroma.