Chronic Hypertension During Pregnancy: Prevalence and Treatment in the United States, 2008-2021.

BACKGROUND: Treatment of chronic hypertension during pregnancy has been shown to reduce the risk of adverse perinatal outcomes. In this study, we examined the prevalence and treatment of chronic hypertension during pregnancy and assessed changes in these outcomes following the release of the updated 2017 hypertension guidelines of the American College of Cardiology and American Heart Association. METHODS: We analyzed the MerativeTM Marketscan® Research Database of United States commercial insurance claims from 2007 to 2021. We assessed the prevalence of chronic hypertension during pregnancy and oral antihypertensive medication use over time. We then performed interrupted time series analyses to evaluate changes in these outcomes. RESULTS: The prevalence of chronic hypertension steadily increased from 1.8% to 3.7% among 1 900 196 pregnancies between 2008 and 2021. Antihypertensive medication use among pregnant individuals with chronic hypertension was relatively stable (57%-60%) over the study period. The proportion of pregnant individuals with chronic hypertension treated with methyldopa or hydrochlorothiazide decreased (from 29% to 2% and from 11% to 5%, respectively), while the proportion treated with labetalol or nifedipine increased (from 19% to 42% and from 9% to 17%, respectively). The prevalence or treatment of chronic hypertension during pregnancy did not change following the 2017 American College of Cardiology and American Heart Association hypertension guidelines. CONCLUSIONS: The prevalence of chronic hypertension during pregnancy doubled between 2008 and 2021 in a nationwide cohort of individuals with commercial insurance. Labetalol replaced methyldopa as the most commonly used antihypertensive during pregnancy. However, only about 60% of individuals with chronic hypertension in pregnancy were treated with antihypertensive medications.

Orthodontic Extraction of High-Risk Impacted Mandibular Third Molars in Close Proximity to the Mandibular Canal: A Systematic Review.

PURPOSE: Extraction of mandibular third molars (M3s) in close proximity to the mandibular canal has some inherent risks to adjacent structures, such as neurologic damage to teeth, bone defects distal to the mandibular second molar (M2), or pathologic fractures in association with enlarged dentigerous cysts. The procedure for extrusion and subsequent extraction of high-risk M3s is called orthodontic extraction. This is a systematic review of the available approaches for orthodontic extraction of impacted mandibular M3s in close proximity to the mandibular canal and their outcomes. MATERIALS AND METHODS: The PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), DOAJ, Google Scholar, OpenGrey, Iranian Science Information Database (SID), Iranmedex, and Irandoc databases were searched using specific keywords up to June 2, 2014. Studies were evaluated based on predetermined eligibility criteria, treatment approaches, and their outcomes. RESULTS: Thirteen articles met the inclusion criteria. A total of 123 impacted teeth were extracted by orthodontic extraction and 2 cases were complicated by transient paresthesia. Three types of biomechanical approaches were used: 1) using the posterior maxillary region as the anchor for orthodontic extrusion of lower M3s, 2) simple cantilever springs attached to the M3 buttonhole, and 3) cantilever springs tied to a bonded orthodontic bracket on the M3 plus multiple-loop spring wire for distal movement of the M3. Osteo-periodontal status of M2s also improved uneventfully. CONCLUSION: Despite the drawbacks of orthodontic extraction, removal of deeply impacted M3s using the described techniques is safe with regard to mandibular nerve injury and neurologic damage. Orthodontic extraction is recommended for extraction of impacted M3s that present a high risk of postoperative osteo-periodontal defects on the distal surface of the adjacent M2 and those associated with dentigerous cysts.

Trends in oral cancer rates in Isfahan, Iran during 1991-2010.

BACKGROUND: There is a variation in trends of oral cancers all over the world. Many investigations have reported evidence of an increasing incidence in oral cancers during recent years. The purpose of this study was to investigate time trend and changes in demographic distribution of oral cancers incidence in Isfahan during 1991-2010. MATERIALS AND METHODS: In this retrospective analytic study archive of Oral Pathology Department of School of Dentistry, Isfahan University of Medical Sciences from 1991 to 2010 were reviewed. A total of 231 Pathology reports were analyzed. Age, sex, primary site, histologic type of cancer, and the referral year were recorded. Data were analyzed by using Jointpoint Regression Program 3 and SPSS 18. P value less than 0.05 consider as significant level. RESULTS: Out of all malignancies, 55% were male and 45% were female. The most frequent cancer was squamous cell carcinoma. Comparing the two time intervals (1991-2000) and (2001-2010) showed that the ratio of carcinomas and salivary gland tumors had decreased while there was an increase in incidence of sarcomas and lymphomas. Among young persons, the occurrence of oral carcinomas (mostly SCC) is rare but sarcomas were more common in younger patients. Gingiva was the most frequently involved in oral cancers with (46%), followed by tongue with (18%). CONCLUSION: : According to this study it revealed that some changes in trends of oral cancer have happened in Isfahan that calls for more study and evaluation of etiologies of these changes.