Evaluation of Delirium Among Elders in the Emergency Department: A Cross-Sectional Study.

BACKGROUND: Health care professionals underestimate the recognition of delirium in emergency departments (EDs). In these settings, between 57% and 83% of cases of delirium go undetected. When delirium occurs, it causes an increase in the length of hospitalization, readmissions within 30 days, and mortality. No studies were carried out in Italy to assess the prevalence of delirium among elders in EDs. OBJECTIVES: The primary goal of the study was to evaluate the prevalence of the risk of delirium in people 65 years and older hospitalized in the ED for a minimum of 8 hours. The study's secondary goal was to identify the variables that influenced the risk of delirium. METHOD: A multicenter cross-sectional study was conducted in 2 EDs. The risk of delirium was assessed using the delirium screening tool 4 A's test. One hundred patients were enrolled. Data collection took place from June 28 to August 31, 2022. RESULTS: The risk of delirium was detected in 29% of the sample, whereas the risk of cognitive impairment was 13%. The use of psychotropic drugs increased the risk of delirium by 11.8 times (odds ratio [OR], 11.80; P = .003). Bed confinement increased the risk by 4.3 times (OR, 4.31; P = .009). Being dehydrated increased the risk of onset by 4.6 times (OR, 4.62; P = .010). Having dementia increased the risk of delirium manifestation by 4.4 times (OR, 4.35; P = .021). DISCUSSION: The risk of delirium was detected in a considerable portion of the sample. The results of this study can be used by health care professionals to implement preventive measures as well as support clinical judgment and establish priorities of care for patients at risk of developing delirium.

3D-3D facial superimposition between monozygotic twins: A novel morphological approach to the assessment of differences due to environmental factors.

Distinction of one twin with respect to the other, based on external appearance, is challenging; nevertheless, facial morphology may provide individualizing features that may help distinguish twin siblings. This study aims at exposing an innovative method for the facial assessment in monozygotic twins for personal identification, based on the registration and comparison of 3D models of faces. Ten couples of monozygotic twins aged between 25 and 69 years were acquired twice by a stereophotogrammetric system (VECTRA-3D® M3: Canfield Scientific, Inc., Fairfield, NJ); the 3D reconstruction of each person was then registered and superimposed onto the model belonging to the same person (self-matches), the corresponding sibling (twin-matches) and to unrelated participants from the other couples (miss-matches); RMS (root mean square) point-to-point distances were automatically calculated for all the 220 superimpositions. One-way ANOVA was used to evaluate the differences among miss-matches, twin-matches and self-matches (p < .05). RMS values for self-matches, twin-matches and miss-matches were respectively 1.0 mm (SD: 0.3 mm), 1.9 mm (0.5 mm) and 3.4 mm (0.70 mm). Statistically significant differences were found among the three groups (p < .01). Comparing RMS values in the three groups, mean facial variability in twin siblings was 55.9% of that assessed between unrelated persons and about twice higher than that observed between models belonging to the same individual. The present study proposed an innovative method for the facial assessment of twin siblings, based on 3D surface analysis, which may provide additional information concerning the relation between genes and environment.

Flapless Versus Traditional Dental Implant Surgery: Long-Term Evaluation of Crestal Bone Resorption.

PURPOSE: The literature reports that flapless compared with traditional implant surgery can be associated with several advantages, including the maintenance of peri-implant hard tissues. This study investigated vertical bone resorption during long-term follow-up after implant placement with flapless versus traditional surgery. MATERIAL AND METHODS: In this prospective, randomized controlled clinical trial, 40 patients underwent implant placement at the Maxillofacial Department Surgery of the Istituto Stomatologico Italiano Hospital in Milan, Italy. Patients were randomly assigned to the control or experimental group. The control group had implants placed with open flap surgery (traditional surgery), whereas the experimental group had implants placed with flapless surgery. The distance between the first implant thread and the marginal crestal bone level was measured at the basal, loading, and long-term control points. The basal recording was performed just after implant placement. The loading measurement was recorded at the time of implant loading, after 2 months of healing for the lower jaw and after 3 months of healing for the upper jaw, and the long-term control record was registered 36 months after implant placement. Statistical analysis was performed using mean values and standard deviations based on bone resorption in the 2 groups. To detect statistical differences, the Student t test was applied. Differences were considered significant if P values were less than .05. RESULTS: The control group (open flap surgery) was comprised of 19 patients, and the experimental group (flapless surgery) was comprised of 21 patients. No statistical differences were found in peri-implant bone resorption between the 2 groups at the basal, implant loading, and 3-year control recordings. CONCLUSION: According to this study, the approach to implant surgery does not seem to influence peri-implant bone resorption in humans, at least for the period measured in this study.

Evaluation of a Three-Dimensional Stereophotogrammetric Method to Identify and Measure the Palatal Surface Area in Children With Unilateral Cleft Lip and Palate.

OBJECTIVE: To assess a three-dimensional (3D) stereophotogrammetric method for area delimitation and evaluation of the dental arches of children with unilateral cleft lip and palate (UCLP). Obtained data were also used to assess the 3D changes occurring in the maxillary arch with the use of orthopedic therapy prior to rhinocheiloplasty and before the first year of life. DESIGN: Within the collaboration between the Università degli Studi di Milano (Italy) and the University CES of Medellin (Colombia), 96 palatal cast models obtained from neonatal patients with UCLP were analyzed using a 3D stereophotogrammetric imaging system. MAIN OUTCOME MEASURES: The area of the minor and greater cleft segments on the digital dental cast surface were delineated by the visualization tool of the stereophotogrammetric software and then examined. "Trueness" of the measurements, as well as systematic and random errors between operators' tracings ("precision") were calculated. RESULTS: The method gave area measurements close to true values (errors lower than 2%), without systematic measurement errors for tracings by both interoperators and intraoperators (P > .05). Statistically significant differences (P < .05) were noted for alveolar segment and time. CONCLUSIONS: Maxillary segments have the potential for growth during presurgical orthopedic treatment in the early neonatal period. The cleft segment delimitation on digital dental casts and area measurements by the 3D stereophotogrammetric system revealed an accurate (true and precise) method for evaluating the stone casts of newborn patients with UCLP.

Sinus lift: 3 years follow up comparing autogenous bone block versus autogenous particulated grafts.

BACKGROUND/PURPOSE: The aim of this prospective randomized controlled clinical trial was to compare vertical bone gain and bone resorption after sinus graft procedures performed either with particulate or with autogenous bone block. MATERIAL AND METHODS: Forty-one patients underwent sinus graft procedures with autogenous bone. They were randomly assigned to one group. The first group of 22 patients was treated with autogenous bone block with or without particulated bone, while in the second group of 19 patients sinus floor elevation was performed only with particulated autogenous bone. Linear measurements were recorded before surgery with a computed tomography scan at surgery and at 36 months after sinus lift grafting with a second computed tomography scan. To detect statistical differences Student t test was applied. Differences were considered significant if P values were < 0.05. RESULTS: There was a statistically significant difference in bone gain for the group treated with bone block grafts. CONCLUSION: As a general clinical guideline the clinician should prefer, wherever feasible, en-block bone grafts for sinus floor augmentation procedures.

Therapeutic efficacy of bromelain in impacted third molar surgery: a randomized controlled clinical study.

OBJECTIVE: Bromelain is the name given to a family of proteolytic enzymes obtained from Ananas comosus, the pineapple plant. It is considered a potent anti-inflammatory and antiedematous substance. Surgery of impacted third molars in the outpatient setting is one of the procedures most often associated with postoperative pain and swelling. The aim of this study was to evaluate the efficacy of bromelain in reducing postoperative pain and swelling. METHOD AND MATERIALS: 80 patients were recruited to the study from patients attending the Maxillofacial Surgery Unit of the Istituto Stomatologico Italiano, Milan, Italy, for impacted third molar surgery. At time 0 when surgery was performed, patients started simultaneous antibiotic and analgesic therapy. On the following day, patients were divided into two groups. Patients in group 1 were prescribed bromelain. Patients in group 2 were prescribed only the analgesic if required. Three parameters were evaluated: pain, edema, and erythema. The first evaluation visit was performed 3 hours after surgery, the second 48 hours after surgery, and the final evaluation 7 days after surgery. RESULTS: Postoperative pain, edema, and erythema were significantly lower in the study group than in the control group. Analgesic consumption, both in terms of days of treatment and number of tablets taken, was slightly lower in the study group. Only one adverse event was recorded, which occurred in a patient in the control group. CONCLUSION: The present study demonstrates an important anti-inflammatory and anti-edematous effect of bromelain. Statistical analysis shows that in the group treated with bromelain the inflammatory response was significantly less than in the control group.

Facial soft-tissue volumes in adult Northern Sudanese individuals with Down syndrome.

OBJECTIVE: To investigate dimensions and ratios of soft-tissue facial volumes of adult Northern Sudanese subjects with Down syndrome by using computerized anthropometric measurements. DESIGN, SETTING, AND PATIENTS: The 3D coordinates of soft-tissue facial landmarks were obtained by a computerized digitizer in 26 Northern Sudanese adult subjects with Down syndrome (18 men, 8 women, aged 17-34 years), and in 99 healthy Northern Sudanese controls (48 women, 51 men) of the same age range. From the landmarks, several facial volumes and volume ratios were calculated. Data were compared to those collected in healthy individuals by computing z-scores. RESULTS: In subjects with Down syndrome, facial volumes were significantly smaller than in control subjects (Student's t, p < 0.05). The patterns of deviation from the norm were similar in men and women. When compared to controls, subjects with Down syndrome had no differences in nose volume as a fraction of total facial volume and a larger total lip volume as a fraction of total facial volume; within the facial middle third, they had relatively larger upper lip volumes and relatively smaller nose volumes. CONCLUSIONS: The facial soft-tissue structures of subjects with Down syndrome differed from those of normal controls of the same age, sex and ethnic group: a reduced facial size was coupled with specific variations in the nasal and labial regions.

Three-dimensional facial distances of Northern Sudanese persons from childhood to young adulthood.

No current age- and gender-related normative data exist for the dimensions of facial structures in Northern Sudanese subjects. In the current study information about normal sex- and age-related linear distances is provided. The three-dimensional coordinates of 14 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 653 healthy Northern Sudanese subjects (326 males and 327 females) aged 4-30 years. From the landmarks, 13 linear distances were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analyzed linear soft tissue facial dimensions were significantly larger in men than in women (p < 0.01), except mouth width (ch-ch), upper facial height (n-sn), mandibular body length (pg-go) and width (go-go). All measurements underwent significant modifications as a function of age (p < 0.01), with significant age × sex interactions (p < 0.01) for all linear dimensions except lower face height (sn-pg). Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human facial morphology during normal growth and development.

Soft tissue facial morphometry in subjects with Moebius syndrome.

Moebius syndrome is a congenital facial palsy associated with the impairment of ocular abduction. The three-dimensional characteristics of the facial soft tissues of 12 male and 14 female subjects [3-52 yr of age (mean age + standard deviation: 17 + 14 yr)] were measured using a non-invasive, computerized system; facial volumes, areas, angles, and distances were computed and compared with those obtained in reference subjects of the same age and gender. When compared with reference subjects, patients with Moebius syndrome had a more prominent and hyperdivergent face in the sagittal plane, a smaller and more prominent upper facial third; a smaller middle facial width; a smaller nose; smaller mandibular volume, depth, corpus length, and ramus height; and a more posterior positioned mandible, with a less prominent chin. In conclusion, patients with Moebius syndrome had a tendency towards a skeletal Class II pattern. These morphological variations may be the combined effect of a general alteration of the motor and sensitive facial nerves, including the trigeminal nerve, and of a maldevelopment of the brainstem.