The 10th Costal Cartilage Graft in Secondary Cleft Rhinoplasty-A Versatile Rib.

Autologous costal cartilage for rhinoplasty is an excellent graft material providing both volume and quality of cartilage required for nasal reconstruction. Commonly, the 5th, 6th, 7th, and 8th rib costal cartilages have been harvested but other ribs such as the 10th rib are often overlooked and yet offer an excellent graft option for columellar, alar rim, nasal tip, and dorsal augmentation grafts. The use of the 10th rib costal cartilage in patients with complex secondary cleft nasal deformity has scant reference in the literature. We demonstrate our simple and quick 10th rib cartilage harvesting technique and elicit its use in secondary rhinoplasty and cleft lip nasal deformities. The advantages of harvesting the 10th rib cartilage and our long-term results demonstrating ease of harvest, stability, and predicable outcomes are with several clinical cases. The senior author has used the 10th rib graft successfully in a variety of challenging secondary cleft rhinoplasty procedures with excellent and consistent outcomes. We advocate the use of the 10th rib graft in such procedures as it is easy to harvest, is a dynamic cartilage graft, and offers predictable results with low levels of complications.

A versatile diphosphine ligand: cis and trans chelation or bridging, with self association through hydrogen bonding.

The diphosphine ligand, N,N'-bis(2-diphenylphosphinoethyl)isophthalamide, dpipa, contains two amide groups and can form cis or trans chelate complexes or cis,cis or trans,trans bridged complexes. The amide groups are likely to be involved in intramolecular or intermolecular hydrogen bonding. This combination of properties of the ligand dpipa leads to very unusual structural properties of its complexes, which often exist as mixtures of monomers and dimers in solution. In the complex [Au2(µ-dpipa)2]Cl2, the ligands adopt the trans,trans bridging mode, with linear gold(I) centers, and the amide groups hydrogen bond to the chloride anions. In [Pt2Cl4(µ-dpipa)2], the ligands adopt the cis,cis bridging mode, with square planar platinum(II) centers, and the amide groups form intermolecular hydrogen bonds to the chloride ligands to form a supramolecular one-dimensional polymer. Both the monomeric and dimeric complexes [PtMe2(dpipa)] and [Pt2Me4(µ-dpipa)2] have cis-PtMe2 units with cis chelating or cis,cis bridging dpipa ligands respectively; each forms a supramolecular dimer through hydrogen bonding between amide groups and each contains an unusual NH···Pt interaction. An attempted oxidative addition reaction with methyl iodide gave the complex [PtIMe(dpipa)], which contains trans chelating dpipa, while a reaction with bromine gave a disordered complex with approximate composition [Pt2Me3Br5(µ-dpipa)2], which contains trans,trans bridging dpipa ligands.

Chemistry of Gold(III) with a Pyridine-Oxaziridine Ligand: Competition between C-O and N-O bond Activation.

The oxaziridine derivative 2-t-butyl-3-(2-pyridinyl)oxaziridine reacted with Na[AuCl4 ].2H2 O to give, after recrystallization from a solvent mixture containing methanol, a mixture of gold(III) complexes which were characterized crystallographically as the amide complex [AuCl2 {κ2 -N,N'-2-C5 H4 NC(=O)N(t-Bu)] and the aldolate complex [AuCl2 {κ2 -N,O-2-C5 H4 NCH(OMe)O)]. It is suggested that these products arise after initial O-N or C-N bond cleavage respectively of the strained oxaziridine ring, after coordination to the gold(III) center. Monitoring of reactions by NMR spectroscopy showed that O-N bond cleavage of the oxaziridine ring was favoured in the presence of a protic solvent.

Impact of Smoking on COVID-19 Symptoms in Non-Vaccinated Patients: A Matched Observational Study from Qatar.

Purpose: Predisposition to acute illness from COVID-19 is suggested to correlate with cigarette smoking as it augments the risk of developing cardiovascular and respiratory illnesses, including infections. However, the effects of smoking on COVID-19 symptoms are not well described and controversial. In this study, we aim to explore the associations between smoking and COVID-19 symptoms. Subjects and Methods: A cross-sectional study using the Ministry of Public Health (MoPH), Qatar database was administered to a Qatari population with confirmed COVID-19 disease who filled in pre-defined phone-call questionnaire between 27th February 2020 and 31st December 2020. We analyzed 11,701 non-vaccinated COVID-19 individuals (2952 smokers and 8749 non-smokers) with confirmed RT-PCR test results. The association of smoking and the presence of symptoms as well as patient characteristics was calculated using Pearson's Chi-square and Fisher's exact tests, adjusting for potential covariates. Results: Compared with the non-smokers, symptomatic COVID-19 infection is significantly higher in smokers. In addition, we found fever as the most common symptom developed in COVID-19 patients followed by cough, headache, muscle ache, and sore throat. As compared to other symptoms, association of smoking with chills and abdominal pain was less evident (P < 0.05 and P < 0.001, respectively). However, both groups showed similar rates of developing cough. Conclusion: In conclusion, smoking is associated with COVID-19 symptoms frequency in non-vaccinated patients; nevertheless, further investigations are necessary to understand the mechanism of this association which could generate new targets for the management of COVID-19 in smoker patients.

Seroprevalence of cytomegalovirus and rubella among pregnant women in western Sudan.

BACKGROUND: Maternal cytomegalovirus (CMV) and rubella infections have adverse neonatal outcomes. Basic epidemiological data concerning CMV and rubella is necessary for health planners and care providers. METHODS: A cross sectional study was conducted at El-Rahad hospital, Sudan to investigate seroprevalence of CMV and rubella infections and associated possible risk factors among pregnant women. Structured questionnaires were used to gather socio-demographic data and ELISA was used to detect CMV and rubella infections using IgG and IgM. RESULTS: Out of 231 pregnant women, 167 (72.2%) and 151 (65.3%) were CMV-IgG and rubella-IgG positive, respectively. Only 6 (2.5%) and 8 women (3.4%) were CMV-IgM and rubella-IgM positive, respectively. While, high parity (OR = 14.7, 95%CI = 1.7 - 123.6; P = 0.01] and illiteracy (OR = 3.0, CI = 1.4 - 6.5; P = 0.004) were significantly associated with seropostive CMV-IgG in multivariate analysis, none of the other obstetrical and medical characteristics were significantly associated with CMV or rubella infections. CONCLUSION: CMV prevalence was 72.2% and rubella susceptibility among pregnant women was 34.6%. Rubella vaccine and routine screening for rubella and CMV should be introduced for pregnant women in this setting. Further research is needed.

Effect of resin coating and occlusal loading on microleakage of Class II computer-aided design/computer-aided manufacturing fabricated ceramic restorations: a confocal microscopic study.

OBJECTIVE: To evaluate the effect of resin coating and occlusal loading on microleakage of class II computer-aided design/computer-aided manufacturing (CAD/CAM) ceramic restorations. MATERIAL AND METHODS: Molars were prepared for an mesio-occlusal-distal (MOD) inlay and were divided into two groups: non-coated (controls); and resin-coated, in which the cavity was coated with a combination of a dentin bonding system (Clearfil Protect Bond) and a flowable resin composite (Clearfil Majesty Flow). Ceramic inlays were fabricated using the CAD/CAM technique (CEREC 3) and cemented with resin cement (Clearfil Esthetic Cement). After 24 h of water storage, the restored teeth in each group were divided into two subgroups: unloaded or loaded with an axial force of 80 N at a rate of 2.5 cycles/s for 250,000 cycles while stored in water. After immersion in 0.25% Rhodamine B solution, the teeth were sectioned bucco-lingually at the mesial and distal boxes. Tandem scanning confocal microscopy (TSM) was used for evaluation of microleakage. The locations of the measurements were assigned to the cavity walls and floor. RESULTS: Loading did not have a significant effect on microleakage in either the resin-coated or non-coated group. Resin coating significantly reduced microleakage regardless of loading. The cavity floor exhibited greater microleakage compared to the cavity wall. TSM observation also revealed that microleakage at the enamel surface was minimal regardless of resin coating. In contrast, non-coated dentin showed extensive leakage, whereas resin-coated dentin showed decreased leakage. CONCLUSIONS: Resin coating with a combination of a dentin-bonding system and a flowable resin composite may be indicated prior to impression-taking when restoring teeth with CAD/CAM ceramic inlays in order to reduce microleakage at the tooth-resin interface.

Difluprednate 0.05% versus Prednisolone Acetate Post-Phacoemulsification for Inflammation and Pain: An Efficacy and Safety Clinical Trial.

BACKGROUND: The purpose of this study was to compare the efficacy and safety of difluprednate 0.05% (PRO-145) versus prednisolone acetate 1% (Prednefrin® SF), for management of postoperative inflammation and pain, after cataract surgery. METHODS: This was a Phase III, multicenter, prospective, double-blind, clinical trial. Intent-to-treat population included 178 post-phacoemulsification patients that were assigned to receive either PRO-145, or prednisolone. One day after unilateral eye surgery, patients instilled a drop 4 times a day for 14 days (then tapering the dose downward for 14 days). The primary efficacy endpoints were anterior chamber (AC) cell grade and flare. Other parameters measured included: retinal central thickness (measured via OCT), conjunctival hyperemia, edema, pain and photophobia. Tolerability and safety were assessed through burning, itching, foreign body sensation, visual acuity (VA), intraocular pressure (IOP) and incidence of adverse events (AE). RESULTS: A total of 171 subjects were randomized (1:1) and completed the study. Compared to day 1, there was a significant improvement in the AC cell count and flare in both groups by the final visit (80.2% vs 88.4%, p=1.000). Conjunctival hyperemia improved in a similar fashion (81.2% vs 79%, p=0.234) in both PRO-145 and prednisolone groups, without differences between them. This was also observed for edema (82.4% vs 82.5%, p=0.246), pain (15.3% vs 7%, p=0.497) and photophobia (16.4% vs 15.1%, p=0.246), respectively. There was no significant difference between treatments for any tolerability parameter studied. Finally, at the 4-week postoperative visit, there were no significant differences between treatments for VA, IOP and AE results (p-values; 0.095, 0.053 and 0.099, respectively). CONCLUSION: The results of this study suggest that PRO-145 is as effective and safe as prednisolone acetate in treating postoperative inflammation and pain in patients undergoing phacoemulsification. The study was registered at ClinicalTrials.gov as NCT03693989.

Effect of resin coating on adhesion and microleakage of computer-aided design/computer-aided manufacturing fabricated all-ceramic crowns after occlusal loading: a laboratory study.

This study investigated the effect of resin coating and occlusal loading on adhesion and microleakage of all-ceramic crowns. Molars were prepared for an all-ceramic crown and were divided into two groups: non-coated (control) and resin-coated with Clearfil Tri-S Bond. Crowns were fabricated using CEREC 3 and cemented using Clearfil Esthetic Cement. After 24 h of storage in water, the restored teeth in each group were divided into two subgroups: unloaded, or loaded while stored in water. Mechanical loading was achieved with an axial force of 80 N at 2.5 cycles s(-1) for 250,000 cycles. After immersion in Rhodamine B, the specimens were sectioned and processed for microleakage evaluation by confocal microscopy, which was followed by further sectioning for microtensile bond testing. Loading had no significant effect on microleakage in either the resin-coated or non-resin-coated groups. Resin coating did not reduce the microleakage at the dentine interface but increased the microleakage at the enamel interface. All the beams fractured during slicing when non-coated and loaded. The bond strengths of non-coated and unloaded, resin-coated and unloaded, and resin-coated and loaded groups were 15.82 +/- 4.22, 15.17 +/- 5.24, and 12.97 +/- 5.82 MPa, respectively. Resin coating with Clearfil Tri-S Bond improved the bonding of resin cement to dentine for loaded specimens. However, it was not effective in reducing the microleakage, regardless of whether it was loaded or unloaded.

Combined correction of the nasal tip and upper lip in bilateral cleft lip patients: A novel approach.

Secondary nasal deformity in bilateral cleft lip is one of the great surgical challenges. The problems are an under projected tip, an infra-tip lobule merging with the pro-labium and a short columella. Upper lip vermillion border deformity is a further significant problem. We demonstrate our novel approach to management by classifying patients into 3 groups depending on the status of important features such as the anatomy of the prolabial skin island, length of columella and upper lip width and fullness. We demonstrate that cleft patients with nasal deformity and poor upper lip aesthetics can be managed with a single operation.

Accent method of voice therapy for treatment of severe muscle tension dysphonia.

Nonorganic dysphonia may present a challenging diagnosis, and management. Here, we present a severe form of nonorganic dysphonia, which we termed as arytenoidal dysphonia. It was a severe form of muscle tension dysphonia, which was described earlier in literature although with different nomenclature. The outcome of the accent method of voice therapy was also presented. We concluded that accent method of voice therapy is proven to be an effective treatment modality of arytenoidal dystonia.

Aberrant temporal branch of facial nerve.

There is a high risk of injury to the temporal branch of the facial nerve during operations on the head and neck because of the complexity of its course. We report an aberrant branch that arose from the main trunk before bifurcation into the temporofacial and cervicofacial divisions. It had no anastomosis with other branches, and damage could have caused uncompensated injury.

Serum magnesium, iron and ferritin levels in patients with diabetic retinopathy attending Makkah Eye Complex, Khartoum, Sudan.

Diabetic retinopathy is the most common complications of diabetes mellitus that, in most occasions, lead to blindness. Multiple evidences linked the serum magnesium, iron and ferritin disturbance with diabetes and its complications. A case-control study was conducted at Makkah Eye Complex, Khartoum, Sudan, to compare the levels of serum magnesium, iron and ferritin in patients with diabetic retinopathy with diabetic patients without diabetic retinopathy (controls). Findings indicate that all patients had type 2 diabetes. The two groups (50 in each arm) were well matched in their basic characteristics. Median (25th-75th interquartile) of serum magnesium in patients with diabetic retinopathy were significantly lower than patients without diabetic retinopathy [1.48 (0.75-1.64) vs. 1.92 (1.4-2.3)mg/dl, P = 0.022]. The median of serum iron and ferritin were lower in cases than control group but did not reach a statistical significance [20.5 (17.2-48.0) vs. 27.0 (16.0-54.0) µg/dl, P = 0.568; 98.0 (45.0-134.75) vs. 101.0 (47.0-161.0) µg/l, P = 0.818]. The duration of diabetes [16.5 (9.3) vs. 11.2 (6.6) years; P = 0.014] and haemoglobin level [13.7 (0.9) vs. 12.5 (2.0) g/dl; P = 0.039] were significantly higher in cases group than control group. A significant inverse correlation was observed between serum magnesium and iron levels. Twenty (40 %) patients had severe non-proliferative diabetic retinopathy with mild macular edema, which is the most prevalent type among the cases group. Hypomagnesaemia among diabetic patients was associated with diabetic retinopathy, while serum iron and ferritin have no significant effect in this setting. Severe non-proliferative diabetic retinopathy with mild macular edema is the prevalent type in this study.

Oral and pharyngeal cancer among the Arab population in Israel from 1970 to 2006.

BACKGROUND: Israeli Arabs are considered as a developing society characterized by poverty and high levels of smoking among men. The purpose of this study was to describe their incidence, mortality and survival rates for oral and pharyngeal cancer between the years 1970-2006. Studies such as this in the Arab world, where the population is almost the same as the Arab population in Israel, are rare. METHODS: The incidence and survival data were derived from all relevant registered data at the National Cancer Registry. The group of lesions included cancer of the lips, tongue, buccal mucosa, floor of the mouth, salivary glands, gums, palate and pharynx. Morphological description was according to WHO classification. RESULTS: Most diagnosed patients were male. The mean age was 54.4 years, and mean years of survival were 3.83. The oropharynx was the most common site (28.3%) while the palate was the least frequent (3.12%). Squamous cell carcinoma (SCC) was the most common histological feature (66.3%), while basal cell carcinoma (BCC) was the least (3.9%). The overall 5 years survival rate was 59.4%, this being highest for BCC (82.1%), while SCC was significantly lower (56.2%) (p<0.001). Lip cancers survived better than other sites. CONCLUSIONS: Data from this society are similar to other developing societies in the majority of the results. The incidence of oral and pharyngeal cancer is lower among the Arab population, in comparison to the Jewish population in Israel.

Self-assembled polymers of silver(I) with a chiral diphosphine ligand.

Silver(I) salts, AgX, form self-assembled polymers with the chiral diphosphine ligand R,R-trans-C(6)H(10)(NHCO-2-C(6)H(4)PPh(2))(2), 1, of formula {Ag(2)X(2)(µ-1)}(n) and ring-opening polymerization of the trans chelate complex [Ag(1)]X has given the helical polymer [{Ag(µ-1)}(n)]X(n), when X = CF(3)SO(3).

A chiral diphosphine as trans-chelate ligand and its relevance to catalysis.

The chiral diphosphine ligand R,R-trans-1,2-C(6)H(10)(NHCOC(6)H(4)PPh(2))(2), 1, gives the fluxional trans-chelate complexes [M(1)]X, 2a-2c, M = Au or Ag. It is suggested that a similar trans-chelate conformation may be present in the catalytic intermediate [Pd(1)].

Síndrome de Weill-Marchesani: Presentación de un caso / Weill-Marchesani syndrome. Case report

El síndrome de Weill-Marchesani es un trastorno raro de herencia recesiva, caracterizado por talla corta, dedos rollizos y cortos y, en ocasiones, retraso mental. Entre las manifestaciones oculares la más importante es la microesferofaquia que, durante la adolescencia o al principio de la segunda década de la vida, puede cursar con una dislocación del cristalino hacia abajo. En ocasiones este síndrome se puede asociar a anomalías del ángulo camerular por disgenesias mesodérmicas y a glaucoma por bloqueo pupilar. El tratamiento en este síndrome dependerá de cada caso.

Síndrome de contracción capsular posterior a cirugía de facoemulsificación. Reporte de un caso / Posterior capsular contraction syndrome after facoemulsification surgery. Case report

Objetivo: Reportar un caso con el síndrome de contracción capsular. Métodos: Descripción de la exploración oftalmógica y de los diferentes procedimientos quirúrgicos realizados. Resultados: Caso clínico de un paciente masculino de 53 años de edad, postoperado de catarata congénita con técnica de facoemulsificación con implante de lente intraocular de silicona, que a los 2 años de operado desarrolló un síndrome de contracción capsular, bajando su capacidad visual de 20/50 a cuenta dedos a 5 pies, requiriendo una nueva intervención quirúrgica consistente en capsulotomía anterior quirúrgica, bajo anestesia local, y posteriormente una capsulotomía posterior con láser de Nd: Yag, recuperando una capacidad visual de 20/80. Conclusiones: Se recomienda no realizar capsulorrexis pequeña; ésta debe ser del tamaño del óptico del lente intraocular a utilizarse, sobre todo en aquellos pacientes de alto riesgo en el desarrollo de esta patología.