Management of a dentigerous cyst; a ten-year clinicopathological study.

BACKGROUND: Dentigerous cysts, deemed of developmental origin, are benign odontogenic cysts characterized by a gradual growth rate. Their occurrence is twice as prevalent in men compared to women. These cysts are recognized as the most frequent developmental cysts affecting the jaws, with a typical manifestation in individuals aged 20 to 40, while infrequently identified in young children. Notably, dentigerous cysts have the potential to attain significant dimensions, resulting in painless enlargement of the jaw and subsequent deformation. OBJECTIVES: To assess the clinicopathological features and management of ten years of experience with dentigerous cysts. METHODS: A challenging cases were reported from reviewed records of the patients who were treated by the surgical intervention of various dentigerous cysts throughout the period of ten years, 2012-2022 and only histologically confirmed cases were selected, at Ramadi Teaching Hospital in addition to Rashid, Razi, Zuhur Private Hospitals and private clinics in Iraq. RESULTS: 76 patients were included in this clinicopathological research. The highest age group affected was ≤ 18 years (68.4%), 54% were male, the mandible was more affected (63.1%) than the maxilla (36.9%). Marsupialization was applied to 30.3% of the cases, while enucleation was carried out in 69.7%. CONCLUSIONS: The significance of meticulous examination of radiographs and the consequences associated with undetected and untreated ailments is affirmed by this case study. A comprehensive understanding of oral pathology serves as a valuable resource for dentists, facilitating accurate diagnosis, appropriate referrals, and the provision of anticipatory guidance to patients striving to achieve optimal oral health across various age groups.

Effect of Lifestyle Counselling via a Mobile Application on Disease Activity Control in Inflammatory Arthritis: A Single-Blinded, Randomized Controlled Study.

BACKGROUND: Mobile applications (apps) are a resource for information on lifestyle and nutrition which are associated to improved outcomes in inflammatory arthritis. OBJECTIVE: The aim of this study was to explore whether targeted lifestyle counselling via an app improves disease activity in arthritis patients. METHODS: Patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), psoriatic arthritis (PsA) were randomized to 12 weeks of lifestyle counselling via an app (Mida, Midaia GmbH, Germany) pertaining to a healthy Mediterranean Diet, physical activity, and mental health. Disease activity was measured with specific instruments by a blinded physician and categorized (remission, low, moderate, high). Dietary adherence was assessed by the Mediterranean Diet Adherence Screener (MEDAS). Mixed effects logistic regression adjusted to baseline disease activity, age, and sex were calculated. RESULTS: Of 158 patients included (73% female, 53.3 ± 11.7 years), 74 were in the active counselling group (ACG). All showed improvement in low disease activity or remission. ACG patients had an odds ratio (OR) of 2.8 (95%-CI 1.1-7.2, p = 0.035), while OR in the control group was not significant OR = 2.1 (0.9-5.0, p = 0.097). The control group was less likely to reach a MEDAS >= 4 (OR = 0.16 (0.03-0.77), p = 0.02), while this was not seen in the ACG (OR = 0.54 (0.06-4.63), p = 0.6). Patients in the ACG showed a tendency towards improved adhesion to a Mediterranean Diet (MEDAS) (ß = 0.35 (-0.05-0.74), p = 0.086). This tendency was not observed in the control group (ß = 0.09 (-0.29-0.46), p = 0.64). CONCLUSIONS: Individualized lifestyle and dietary counselling via app may help to improve disease control in inflammatory arthritis patients.

Capturing CO2 through High Surface Area Activated Carbon Derived from Seed Shells of Balanites Aegyptiaca.

Activated carbon is an attractive adsorbent for capturing various environmental pollutants, including CO2. Herein, an optimal synthesis and impressive performance of activated carbon made from Balanites aegyptiaca (Desert date) seed shells is reported, which is an abundant agricultural waste in the Middle East and Africa. The synthesis route involved pretreating the biomass with KOH and heating it under a suitable temperature profile. An optimal KOH-to-biomass ratio and multi-stage carbonization yielded activated carbon with a surface area above 3000 m2/g and an average pore size of nearly 4.1 nm. At 0 °C, this activated carbon exhibited CO2 uptake of 11.3 mmol g-1 that surpassed the uptake capacity of previously reported activated carbons. The selectivity towards CO2 was also found to be significantly higher compared to other gases. Thus, the present approach demonstrates an efficient conversion of agricultural waste to activated carbon for capturing CO2 and other environmental contaminants.

Benign multinodular goitre presenting as acute decompensated type two respiratory failure.

Acute airway obstruction is a life-threatening complication of benign goitre mostly occurring in cases of known progressing goitres. The index presentation of goitre with decompensated type two respiratory failure is an exceedingly rare and a diagnostically challenging presentation. We discuss the case of a woman in her 50 s, who had been diagnosed with asthma by her general practitioner, but during admission was found to have a large goitre with retrosternal extension causing critical tracheal compression. She presented with acute decompensated type two respiratory failure. We explore the diagnostic confounding posed by the patient's background of asthma and describe the initial management of the patient with non-invasive ventilation by the emergency department. The diagnosis of upper airway obstruction was not apparent which is an interesting anomaly in this case. She underwent an emergency hemithyroidectomy and recovered with a resolution of her respiratory symptoms. Histology confirmed benign multinodular hyperplasia.

Changes in social care after major emergency general surgery procedures.

BACKGROUND: Emergency general surgery (EGS) is a major part of the provision of healthcare, and patients undergoing EGS are at elevated risk of morbidity and mortality. This study aimed to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. METHODS: Our local data uploaded to the National Emergency Laparotomy Audit (NELA) (2014-2022) were analyzed. This national database encompasses all major EGS cases undertaken in the United Kingdom. The variables considered were patient demographics, American Society of Anesthesiologists score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on postdischarge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement after discharge. Significance was set at P < .05. RESULTS: Data from all patients in the NELA database (n = 1611) were analyzed. Approximately 1 in 10 patients older than 70 years never returned home. Patients requiring additional support were on average 8.6 years older (P = .008). At older than 80 years, the need for extra social support increased substantially with each increasing year in age, and those older than 85 years were more than twice as likely to require extra support than 80-year-olds (P < .001). Patients who died were 11.4 years older than those discharged without additional support (P < .001). CONCLUSION: A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care postemergency surgery. These important social factors need to be considered before operating given that they may have significant quality of life and economic implications.

Advances in Diagnosis and Treatment of Basal Cell Carcinoma.

Basal cell carcinoma (BCC) is one among the most prevalent malignant neoplasms that has exhibited a notable surge in global incidence over recent decades. This slow-growing malignancy is typified by its localized invasiveness while demonstrating an exceedingly rare metastatic proclivity. It predominantly afflicts the sun-exposed skin of aging individuals, with a heightened predilection for the maxillofacial region. Scraping cytology offers numerous benefits, including the potential for an earlier diagnosis and the absence of scarring, as opposed to a biopsy. The cytodiagnosis of BCC proves to be straightforward with various techniques, making it highly advantageous in an outpatient environment as a swift diagnostic method when planning a surgical excision. Our study sought to scrutinize the clinicopathological facets of BCC within the maxillofacial region. We compared advanced cytological techniques for diagnosis, including scraping, scratching, and imprinting using Papanicolau and Diff-Quick stains. In addition, we evaluated the therapeutic effectiveness of diode lasers operating at wavelengths of 940nm and 980n. A retrospective analysis was undertaken, encompassing facial BCC lesions smaller than 2.5 cm in diameter that underwent treatment through diode laser ablation between September 2021 and August 2023 at Ramadi Teaching Hospital and a private clinic in Ramadi City, Iraq. Among the cohort of 48 patients with BCC, a majority (58%) were 50 years of age or older, with a predominance of males (62%). The mean duration of lesion existence exceeded 4 months. The anatomical region most commonly involved was the middle 1/3 of the face, accounting for 34% of cases. Intriguingly, the therapeutic approach of diode laser ablation yielded exceptional esthetic and functional outcomes, which were consistently observed throughout the follow-up period post-healing. The occurrence of complications following diode laser ablation was relatively infrequent. This investigation revealed that cytological examination is easily conducted, eliminating the need for local anesthesia, saving time, being more cost-effective than a conventional biopsy, and delivering swift diagnoses. The process of smear-taking for cytology is well-tolerated, inflicting minimal trauma or discomfort on the patient. BCC predominantly afflicts elderly males and most frequently affects the middle third of the face. Notably, nodular BCC emerged as the prevailing histological subtype. The use of diode laser ablation exhibited a commendable track record, producing exemplary functional and esthetic outcomes over a 6-month follow-up period.

Human cancer risk due to chromium and its bioaccumulation in physids in Central Punjab, Pakistan.

The present study aims to assess the ecological risk of chromium [Cr(VI)] in the water and soil of Central Punjab and its natural bioremediation through physids. Members of the genus Physa are cosmopolitan as they are resistant to various pollutants. The snails of the genus Physa were sampled from October through March. Three species, i.e., P. acuta, P. fontinalis, and P. gyrina, were identified. The foot, shell, water, and soil samples were tested for the presence of the hexavalent chromium, using ICP-MS. The maximum mean concentration of chromium in soil was found in GB(R8), i.e., 2.66 ppb. The maximum mean concentration of chromium in water was found in RB(R4), 1.627 ppb. The highest maximum average daily dose (ADD) was found in RB:R6, with a hazard quotient (HQ) of 32.32 and a carcinogenic risk (CR) of approximately 20 in every 100 children as a result of water pollution which is quite similar to RB:R5 showing these are extremely polluted area due to chromium. The pollution level of chromium in soil of Faisalabad is less than zero and safe while water is unsuitable for drinking as the value of water quality index (WQI) is higher than 100. No significant difference among the three species was found regarding bioaccumulation of chromium, in the snail shell and body. Physids play an active role in the bioremediation of soil and water yet may become cancer-causing tablets in the food chains of the region.

Islamic Civilizations and Plagues: The Role of Religion, Faith and Psychology During Pandemics.

The current study seeks to analyze Muslim experiences of communicative diseases with a focus on the psychosocial impacts and public, communal, and personal responses of Muslim populations throughout history. By examining a selection of plague outbreaks between the 8-19th centuries across the lands broadly defined as the Islamic Mediterranean (Varlik, 2017), the guidelines and coping mechanisms that Muslims extracted from their traditional sources are highlighted. This historical perspective contributes to a better understanding of the psychological and social aspects of pandemics for the Muslim community, specifically for the role played by faith and spirituality as determinants of psychological well-being in Muslims' perceptions and responses. We suggest that such an understanding is especially useful for contemporary mental health practitioners working with Muslim patients through the global COVID-19 pandemic.

Content and strength of conflict of interest policies at Scandinavian medical schools: a cross sectional study.

BACKGROUND: Concerns around staffs' and students' interactions with commercial entities, for example drug companies, have led several North American medical schools to implement conflict of interest (COI) policies. However, little is known about COI policies at European medical schools. We analysed the content and strength of COI policies at Scandinavian medical schools. METHODS: We searched the websites of medical schools in Denmark, Norway, and Sweden and emailed the Deans for additional information. Using comparable methodology to previous studies, the strength of the COI policies was rated on a scale from 0 to 2 across 11 items (higher score more restrictive); we also assessed the presence of oversight mechanisms and sanctions. RESULTS: We identified 77 unique policies for 15 medical schools (range 2-8 per school). Most of the policies (n = 72; 94%) were University wide and only five (6%) were specific for the medical schools. For six of eleven items one or more schools had a restrictive policy (score of two). None of the schools had a restrictive policy for the five additional items (speaking relationships, sales representatives, on-site education activities, medical school curriculum, and drug samples). Honoraria was the item with the highest score, with eight of the 15 schools having a score of two. Thirteen of the 15 schools had policies that identified a party responsible for policy oversight and mentioned sanctions for non-compliance. CONCLUSION: Our study provides the first evaluation of all Scandinavian medical schools' COI policies. We found that the content of COI policies varies widely and still has shortcomings. We encourage Scandinavian medical schools to develop more stringent COI policies to regulate industry interactions with both faculty and students.

Apparent diffusion coefficient (ADC): A potential in vivo biological surrogate of the incidentally discovered bone lesions at 3T MRI.

PURPOSE: To probe the potential of apparent diffusion coefficient (ADC) to rectify the incidentally detected bone lesion on MRI into benign or malignant lesions. MATERIALS AND METHODS: We retrospectively recruited 44 patients (24 males and 20 females); with 52 bone lesions, who underwent diffusion weighted (DW) imaging using multiple b-values on 3 T MRI. ADC maps were derived and analyzed by two radiologists; blinded to the final diagnosis. The mean ADC values were used for statistical analyses. The diagnosis was deduced by histopathological confirmation; in 32 lesions and strict clinical and imaging follow-up for at least 12 months; in 20 lesions. RESULTS: The mean ADC value (mean±SD) of all malignant tumors (including cartilaginous neoplasms) was [0.92 ± 0.40] × 10-3 mm2/s. This significantly differed from those of both primary benign tumors [1.14 ± 0.24] × 10-3 mm2/s, (p = 0.011), and all non-malignant lesions collectively [1.29 ± 0.44] × 10-3 mm2/s, (p < 0.001). Using mADC value of ≤ 1.1 × 10-3 mm2/s resulted in 86.1% sensitivity and 62.5% specificity for characterizing a lesion as a malignant. The inter-rater reliability was almost perfect (95% CI = 0.954-0.985). CONCLUSION: ADC could be a non-invasive in-vivo surrogate that may be able to discern the incidentally discovered osseous lesions into benign and malignant pathologies and guide further diagnostic workup.

The emerging role of 3D printing in water desalination.

Unmatched flexibility in terms of material selection, design and scalability, along with gradually decreasing cost, has led 3D printing to gain significant attention in various water treatment and desalination applications. In desalination, 3D printing has been applied to improve the energy efficiency of existing technologies. For thermal desalination, this involves the use of 3D printed components that enhance water evaporation and energy harvesting with new materials and designs. For membrane-based desalination, 3D printing offers membranes and other module components with customized materials and geometries for better fouling resistance and productivity. This review highlights the current status, advances and challenges associated with 3D printing in both thermal and membrane-based desalination technologies. Other unique benefits offered by 3D printing for water desalination along with the associated challenges are also discussed in this review. Finally, the future prospects and research directions are highlighted related to the application of 3D printing in the water desalination industry.

Waist-to-Height Ratio (WHtR) in Predicting Coronary Artery Disease Compared to Body Mass Index and Waist Circumference in a Single Center from Saudi Arabia.

This study aims to study the efficiency of the Waist-to-Height Ratio (WHtR) for determining coronary artery disease. It compares the frequency of abnormal WHtR, as a proxy for abdominal obesity, to that of body mass index (BMI) and waist circumference (WC). It also relates the findings to other cardiometabolic risk factors in University Hospital patients. A cross-sectional study design was used, where a sample of 200 patients (142 males and 58 females) who attended the adult cardiac clinic were purposively included. BMI, WC, and WHtR were measured, where frequencies of WHtR were compared to those of BMI and WC. The findings were related to the history of coronary artery disease (CAD) and history of cardiometabolic risk factors, including diabetes mellitus (DM), hypertension (HTN), and hyperlipidemia. Majority of the male patients were older, taller, and had a lower BMI value. It also showed that the prevalence of dyslipidemia and CAD was higher in male patients. No significant difference between both genders was noticed for weight, WC, WHtR, hypertension, or DM. BMI was least associated with high-risk cardiac population in both males and females (39.4% and 60.3%), followed by WC (84.5% and 96.6%, respectively). WHtR showed the highest association with gender (male 98.6% and females 98.3%). These findings were noticed in patients with all risk factors. WHtR is superior to BMI and WC for determining the elevated risk of diabetes, hypertension, dyslipidemia, and CAD in a single university institute. The role of WHtR in both normal and diseased Saudi population should be delineated.

Gene expression analysis in scars treated with silicone cream: a case series.

BACKGROUND: In contrast to fetal scar tissue, adult scar tissue presents with visible scarring. Topical silicone creams have been shown to improve the appearance of scars. This case series compares the genetic expression of post-surgical scar tissues that received topical scar treatment with silicone cream, SKN2017B, or no treatment. SKN2017B is a recently formulated silicone-based scar cream that contains selective synthetic recombinant human growth factors, hyaluronic acid, and vitamin C. We hypothesise that scars treated with silicone-based scar creams have a more favourable genetic expression resembling a well-healing scar. METHODS: Women who had undergone an abdominoplasty were included in this investigation and randomly assigned to treat part of the scar with topical silicone, another part with SKN2017B, and to leave a third part untreated. After four weeks, punch biopsies were taken and the RNA sequenced. Healthy abdominal skin was biopsied as baseline data. Genes of interest were identified and median values were calculated for the samples. RESULTS: SKN2107B-treated scars demonstrated the lowest collagen type I to collagen type III ratio. Other key genes of interest in wound healing showed the lowest (favourable) expression of fibroblast activation protein alpha, lysyl oxidase and cartilage oligomeric matrix protein; the highest (favourable) expression of fibronectin type III domain containing 1 and matrix metallopeptidase 9 were found in scars treated with SKN2017B. CONCLUSION: The results of this small case series demonstrate a trend that those scars treated with topical silicone cream, notably SKN2017B, display the most favourable gene expression for wound healing.

Direct Quantification of Rapid and Efficient Single-Stroke Actuation by a Martensitic Transition in a Thermosalient Crystal.

Molecular dynamic crystals conveniently combine flexibility required for mechanical reconfiguration, strength for effective translation of elastic energy, and long-range order of mechanically coupled molecules for rapid conversion of disordered motion (heat) or photons (light) into ordered motion (work). By direct measurement of the actuation force generated by crystals of a thermosalient solid, here we describe the first direct quantification of the work performed and energy conversion that can be accomplished by using dynamic crystals as supramolecular actuators. Upon reversible α-to-γ phase transition, crystals of (phenylazophenyl)palladium hexafluoroacetylacetonate of submillimeter to millimeter size exert forces in the range of 1-100 mN upon longitudinal and lateral expansion. This work translates to a volumetric power density of about 1-3 MW m-3 and efficiency comparable to the existing multicomponent actuators.

Metal-coated thermosalient crystals as electrical fuses.

Silver-coated 1,2,4,5-tetrabromobenzene crystals, a thermosalient compound, are presented as novel electrical fuse materials. These electrically conductive crystals exhibit linear characteristics up to a threshold value where the resistive heating triggers their phase transformation. This causes mechanical motion of the crystals with immediate circuit breakage. The concept described here opens new avenues for next-generation electrical fuses.

Stromal modulation and its role in the diagnosis of papillary patterned thyroid lesions.

The papillary patterned lesion of thyroid may be challenging with many diagnostic pitfalls. Tumor stroma plays an important part in the determination of the tumor phenotype. CD34 is thought to be involved in the modulation of cell adhesion and signal transduction as CD34(+) fibrocytes are potent antigen-presenting cells. Smooth muscle actin (SMA) positivity could be diagnostic for fibroblast activation during tumorigenesis. We aimed to examine the expression of CD34 and alphaSMA in the stroma of papillary thyroid hyperplasia, papillary thyroid carcinoma and papillary tumors of uncertain malignant potential in order to elucidate their possible differential distribution and roles. A total number of 54 cases with papillary thyroid lesions were studied by routine HandE staining, CD34 and ASMA immunostaining. ASMA was not expressed in benign papillary hyperplastic lesions while it was expressed in papillary carcinoma, indicating that tumors have modulated stroma. Although the stroma was not well developed in papillary lesions with equivocal features of uncertain potentiality, CD34 was notable in such cases with higher incidence in malignant cases. So ASMA as well as CD34 could predict neoplastic behavior, pointing to the importance of the stromal role. Differences between groups suggest that the presence of CD34 + stromal cells is an early event in carcinogensis and is associated with neoplasia, however ASMA+ cells are more likely to be associated with malignant behavior and metastatic potential adding additional tools to the light microscopic picture helping in diagnosis of problematic cases with HandE.

Acute carpal tunnel syndrome from burns of the hand and wrist.

Acute median nerve compression usually occurs from increased pressure within the carpal tunnel and forearm compartments. Although the hyperesthesia from burns may mimic symptoms of acute compression neuropathy, clinical diagnosis should be made from history, clinical signs and symptoms. Early recognition and decompression of the carpal tunnel either as part of the burn excision or along with escharotomy usually leads to full recovery.

Closure of massive abdominal wall defects: a case report using the abdominal reapproximation anchor (ABRA) system.

Closure of massive abdominal wounds can be a challenging surgical problem. Presented here is a novel technique for reconstitution of the abdominal wall after severe internal injuries complicated by sepsis required a prolonged period of open abdominal dressing changes. By using an innovative and effective progressive tension band system, the fascial edges could be reapproximated over time allowing primary wound closure. This system is recommended as an effective instrument to accomplish closure of these difficult wounds.

Reconstruction of a transmetatarsal amputation stump using a salvaged peroneal artery fasciocutaneous flap from the opposite leg: A case report.

During lower extremity amputation, the objective is to provide a functional residual limb that permits maximum patient mobility and independence. Preservation of length of the fore part of the foot using salvageable tissue from the amputated part in young patients prevents equines deformity and revision of amputation to a higher level. This can be achieved using tissue available from the amputated part. The spare part concept in reconstructive surgery should be integrated into the trauma algorithm to avoid additional donor site morbidity. Reported here is a young adult patient with crush injuries to both feet, which resulted in amputations. A fasciocutaneous flap raised from one extremity was used to facilitate transmetatarsal amputation stump length preservation of the other extremity.

Pendant l'amputation de l'extrémité inférieure, l'objectif consiste à obtenir un membre résiduel fonctionnel qui assure la mobilité et l'indépendance maximales du patient. Chez les jeunes patients, la préservation de la longueur de la partie avant du pied à l'aide de tissu récupérable de la partie amputée permet d'éviter les malformations équines et la révision de l'amputation à un niveau plus élevé. Le concept de pièce de rechange en chirurgie reconstructive devrait être intégré à l'algorithme du traumatisme pour éviter la morbidité additionnelle au foyer du donneur. Est exposé le cas d'un jeune patient adulte ayant des lésions par écrasement aux deux pieds, qui ont provoqué des amputations. Un lambeau fasciocutané prélevé sur une extrémité a facilité la préservation de la longueur du moignon de l'amputation transmétatarsienne de l'autre extrémité.