Reconstruction of Congenital Arhinia With Stereolithographic Modeling: Case Correlate and Literature Review.

Complete congenital arhinia is a rare defect of embryogenesis leading to the absence of the external nose and airway. We report our novel multistaged reconstructive approach and literature review. Nasal methyl methacrylate prosthesis was created from a stereolithographic model for use as a temporary prosthesis and tissue expander. Lefort 1 with cannulization was utilized for midface advancement and airway formation. External framework was reconstructed with bilateral conchal bowl cartilage and rib osteocartilagenous grafts. Patient was pleased with the aesthetics and had safe decannulation with the ability to breathe through the nose and airway.

An In-Vitro Assessment of Operator Accuracy and Inter-Operator Agreement in Recording Shade and Shade Characteristics.

Color assessment remains a challenging aspect of esthetic dentistry. This study aimed to evaluate inter-operator agreement and accuracy in assessing shade parameters and to investigate the effect of different clinical backgrounds of the operators under different lighting conditions. Three veneers with a single shade (VITA VM7, shade 2M2: VITA Zahnfabrik, Bad Säckingen) and different shade characteristics (lustre, translucency and opacity) were assessed by 24 operators with different backgrounds using natural and color-corrected light (Trueshade, Interempresas Media, S.L.U. - Grupo Nova Àgora, Spain). Shade assessment accuracy was only 5.5% using natural light and 9.7% using Trueshade. The majority of operators identified value and hue correctly, although chroma was mostly identified incorrectly. The most accurate assessments were recorded by technicians, and translucency was the characteristic to be least accurately recorded. Inter-operator agreement of shade was better with Trueshade compared without Trueshade, although group agreements of shade characteristics were higher without Trueshade for lustre and opacity, but not for translucency. Operators showed limited agreement and poor accuracy in assessing shade and shade characteristics and the clinical background had an effect on shade selection. Technicians were more reliable in shade assessment. Trueshade could be a promising tool to improve shade assessment outcomes.

Ocular co-morbidities in patients with atopic dermatitis - a cross-sectional study from a tertiary referral hospital, Malaysia.

INTRODUCTION: Atopic dermatitis (AD) is a chronic relapsing pruritic inflammatory skin disease that commonly occurs among children as well as adults. AD patients were reported to have high prevalence of ocular manifestations, which may be due to the disease nature or drug complications. This study aimed to determine the prevalence of ocular manifestations in patients with AD. MATERIALS AND METHODS: Eighty patients who fulfilled the UK Working Party's Diagnostic Criteria for Atopic Dermatitis were included in the cross-sectional study. A standardized case report form was formulated to collect the demographic data and disease profile of the participants. AD severity was evaluated using the EASI and SCORAD score. All patients underwent a complete ophthalmological evaluation. RESULTS: The prevalence of ocular manifestations among the patients with AD was 48.8%. Fifty-four (67.5%) patients had facial dermatitis and 37 (46.2%) showed periorbital signs. The mean AD disease duration was 10.99 ± 11.20 years. Majority of the patients had mild to moderate AD. The most frequent ocular manifestation was allergic conjunctivitis (18.75%) followed by cataract (8.75%) and ocular hypertension (8.75%). Among the patients with ocular manifestations, 27 (69.2%) patients regularly applied topical corticosteroids on the face. The use of systemic corticosteroids was seen in 19 (42.2%) patients. Prolonged AD duration was significantly associated with the development of ocular manifestations. CONCLUSIONS: Nearly half of the patients with AD were complicated with ocular disease regardless of the AD severity, facial dermatitis and presence of periorbital signs. Long disease duration is associated with ocular manifestations, especially steroid related complications.

Migrant and refugee Oral Health.

This issue contains two papers on the oral health of migrant people. The oral health of migrants, refugees, and asylum seekers is often worse than the general oral health of the host country's population (Crespo, 2019; Davidson et al., 2006). Poor oral health outcomes in migrants are due to a combination of upstream, psychosocial, and behavioral factors. Migrant communities might then have vital priorities that compete with oral health. Consequently, they may express lower needs and may not focus on oral health; all these factors lead to a higher risk of developing dental diseases. Lack of oral health services is commonly seen due to limited fi nancial resources or lack of dental providers in the vicinity of migrant communities or refugee camps. They face ad- ditional cultural and linguistic barriers in navigating the health care system of a new country.

Oral health status and risk determinants in adult Syrian refugees in Jordan.

OBJECTIVES: Lack of data regarding the oral health of Syrian refugees represents a crucial gap in the literature. This study aimed to investigate the oral health status of Syrian refugees and related socio and behavioral factors. BASIC RESEARCH DESIGN: Cross-sectional study from June to September 2019 at Zaatari refugee camp, Jordan. METHODS: An experienced, calibrated field investigator performed an oral clinical examination of 505 Syrian refugees (18-60 years) using the WHO criteria. DMFT, SiC, oral health indices and socio-demographic variables were recorded. RESULTS: A total of 264 males and 241 females were included. The prevalence of caries was 96.0%, of which 76.0% had 4-17 carious lesions. The mean number of decayed, missing and filled teeth was 5.76, 2.55 and 1.88 respectively. The mean DMFT score was 10.19 (100% had DMFT⟩0), SiC was 17.09, and the mean simplified Oral hygiene index score was 2.18. The most common chief complaint was pain (92.7%). Nearly half of the participants were smokers (45.7%). There was a negative association between level of education and oral health (P=0.011). Most participants did not brush their teeth regularly (87.5%). Females had better oral hygiene practices than males (P=0.015). CONCLUSIONS: Syrian refugees had a high prevalence of caries, high unmet dental treatment needs and poor oral hygiene practices. Preventive programs and focused interventions may reduce the burden of disease in this underprivileged population, on funding agencies and host countries as well.

Parental perception and acceptance of silver diamine fluoride treatment among Syrian refugees.

OBJECTIVE: Silver diamine fluoride (SDF) is an effective cariostatic agent, although staining associated with treatment is a significant impediment to its acceptability. BASIC RESEARCH DESIGN: A cross-sectional study of Syrian refugees to identify acceptance of SDF treatment. METHODS: Information was collected on: sociodemographics, medical/dental child history, dental status (dmft/DMFT), andperceptions of photographs of SDF-treated teeth. Associations between clinical findings and the acceptability were assessed. RESULTS: Of 258 parents or guardians, 37.8% accepted SDF treatment for their children. Acceptance was related to the location and type of teeth, being higher for primary than permanent teeth, and posterior than anterior teeth in both dentitions. Uncooperative behavior during previous dental treatment, the presence of dental discoloration, history of child dental pain, and number of filled teeth were all associated with better parental acceptance. Acceptance was also related to parental age, level of education, and their relation to the child. CONCLUSION: Parents' acceptance of SDF treatment is low. However, staining on posterior teeth was more acceptable than staining on anterior teeth and on primary more than permanent teeth.

Blindness Secondary to Orbital Giant Cell Granuloma Mass-Effect in Noonan Syndrome With Return of Vision Following Surgical Decompression.

ABSTRACT: Noonan syndrome is a rare, autosomal dominant disorder encompassing multiple congenital defects, as well as association with solid tumor and lesion development. The authors present a 26-year-old female with known Noonan syndrome and ongoing complaint of worsening unilateral vision, progressing to vision loss due to lesion mass effect. Decompressive surgery was performed, restoring patient's vision to baseline immediately postoperative. The lesion was confirmed to be giant cell granuloma. In this paper we discuss the unique presentation of vision loss due to orbital giant cell granuloma in Noonan syndrome with postoperative return of vision; the importance of a multi-disciplinary team evaluation, thorough preoperative clinical and image-based work up, intraoperative findings, postoperative outcome, and complexity of definitive management.

High-intensity interval training induced PGC-1∝ and AdipoR1 gene expressions and improved insulin sensitivity in obese individuals.

INTRODUCTION: High-intensity interval training (HIIT) has been found to improve cardiometabolic health outcome as compared to moderate-intensity continuous exercise. However, there is still limited data on the benefits of HIIT on the expression of regulatory proteins that are linked to skeletal muscle metabolism and insulin sensitivity in obese adults. This study investigated the effects of HIIT intervention on expressions of peroxisome proliferatoractivated receptor-γ coactivator 1-∝ (PGC-1∝) and adiponectin receptor-1 (AdipoR1), insulin sensitivity (HOMAIR index), and body composition in overweight/obese individuals. METHODS: Fifty overweight/obese individuals aged 22-29 years were assigned to either no-exercise control (n=25) or HIIT (n=25) group. The HIIT group underwent a 12-week intervention, three days/week, with intensity of 65-80% of age-based maximum heart rate. Anthropometric measurements, homeostatic model of insulin resistance (HOMA-IR) and gene expression analysis were conducted at baseline and post intervention. RESULTS: Significant time-by-group interactions (p<0.001) were found for body weight, BMI, waist circumference and body fat percentage. The HIIT group had lower body weight (2.3%, p<0.001), BMI (2.7%, p<0.001), waist circumference (2.4%, p<0.001) and body fat percentage (4.3%, p<0.001) post intervention. Compared to baseline, expressions of PGC-1∝ and AdipoR1 were increased by approximately three-fold (p=0.019) and two-fold (p=0.003) respectively, along with improved insulin sensitivity (33%, p=0.019) in the HIIT group. CONCLUSION: Findings suggest that HIIT possibly improved insulin sensitivity through modulation of PGC-1∝ and AdipoR1. This study also showed that improved metabolic responses can occur despite modest reduction in body weight in overweight/obese individuals undergoing HIIT intervention.

[Repetitive resection and intrasurgery radiation therapy of brain malignant gliomas: history of question and modern state of problem]. / Povtornaia rezektsiia i intraoperatsionnaia luchevaia terapiia zlokachestvennykh gliom golovnogo mozga: istoricheskii ékskurs i sovremennoe sostoianie problemy.

Numerous studies have shown that the degree of primary resection of malignant gliomas of the brain (MG) directly correlates with rates of relapse-free and overall patient survival. Currently, there is no unequivocal opinion regarding the indications and effectiveness of repeated resection in relapse of MG after combined treatment. Surgical intervention, taking into account the pathomorphological features of these tumors, is not healing and should be supplemented with certain methods of adjuvant treatment. The article reviews and analyzes publications devoted to repeated resection and various methods of intraoperative radiation therapy in the treatment of MG. Based on the analysis, the authors of the article came to the conclusion that it is advisable to start their own research on the use of intraoperative balloon brachytherapy in the treatment of recurrent MG based on modern technological solutions.

25 (OH) VITAMIN D DEFICIENCY IN HEMODIALYSIS (HD) PATIENTS AND A MATCHING SAMPLE OF THE GENERAL POPULATION: EXPERIENCE OF ONE CENTER. A Pilot Study.

INTRODUCTION: 25 (OH) vitamin D plays an important role in many places through the body. Its deficien- cy can cause rickets or osteomalacia. This is particularly im- portant in hemodialysis (HD) patients who are at icreased risk due to decreased sunlight exposure and deterioration of their mineral homeostasis. OBJECTIVES: To determine the prevalence of 25 (OH) vitamin D deficiency in HD patients at Rafic Hariri University Hospital (RHUH), compared to a sample of the general population matched for gender and age, and to evaluate the effectiveness of 25 (OH) vitamin D supplementation in HD deficient group. METHODS: This is a cross sectional study conducted since December 2012, comparing the prevalence of 25 (OH) vitamin D deficiency in HD patients in the dialysis center at RHUH, with patients from the general population who sought medical attention at RHUH for purposes other than HD, matched for age and gender. 25 (OH) vitamin D levels were measured with radio- immunoassay method (LOINC) at CIC European Lab, Bar- celona, Spain. A pilot study was conducted with the 34 HD patients who turned out to be deficient or insufficient in 25 (OH) vitamin D. We supplemented them with cholecalciferol over 6 months. We then assessed their vitamin D levels, and biochemistry parameters. RESULTS: The prevalence of 25 (OH) vitamin D deficiency in the sample of HD patients at baseline was 32% while that of insufficiency was 36%. The prevalence of 25 (OH) vitamin D deficiency in the sample of general population was 67%. No correlation was found be- tween 25 (OH) vitamin D levels and the studied parameters. In the pilot study, after six months of cholecalciferol supple- mentation, there was a significant improvement in 25 (OH) vitamin D levels in the deficient and insufficient groups. CONCLUSION: The sample studied in the general population showed high prevalence of 25 (OH) vitamin D deficiency (67%). The sample studied in HD patients showed a preva- lence of 25 (OH) vitamin D deficiency of 32% and insuffi- ciency of 36%. The pilot study showed that 25 (OH) vitamin D supplementation in the form of cholecalciferol is beneficial in HD patients.

Morphological and phenotypical characteristics of human osteoblasts after short-term space mission.

Morphological and phenotypical signs of cultured readaptation osteoblasts were studied after a short-term space mission. The ultrastructure and phenotype of human osteoblasts after Soyuz TMA-11 space flight (2007) were evaluated by scanning electron microscopy, laser confocal microscopy, and ELISA. The morphofunctional changes in cell cultures persisted after 12 passages. Osteoblasts retained the drastic changes in their shape and size, contour deformation, disorganization of the microtubular network, redistribution of organelles and specialized structures of the plasmalemma in comparison with the ground control cells. On the other hand, the expression of osteoprotegerin and osteocalcin (bone metabolism markers) increased; the expression of bone resorption markers ICAM-1 and IL-6 also increased, while the expression of VCAM-1 decreased. Hence, space flight led to the development of persistent shifts in cultured osteoblasts indicating injuries to the cytoskeleton and the phenotype changes, indicating modulation of bone metabolism biomarkers.

Transient 2:1 Atrioventricular Block with Peri-Conduction System Pacing After Leadless Pacemaker Implantation.

This report discusses a case of transient 2:1 atrioventricular block with conduction system pacing 4 hours after leadless right ventricular pacemaker implantation in a 19-year-old patient with a history of cardioinhibitory syncope and asystole cardiac arrest but without preexisting atrioventricular block. The atrioventricular block was resolved spontaneously. Pacing morphology was suggestive of right bundle branch pacing. Neither 2:1 atrioventricular block nor conduction system pacing has previously been a reported outcome of right ventricular leadless pacemaker implantation. The report demonstrates that conduction system pacing with leadless devices is achievable. Further study of techniques, limitations, and complications related to intentional right ventricular leadless conduction system pacing is warranted.

The contribution of homestead pond fish culture to household food security and dietary diversity in central coast of a developing country.

Fish farming in homestead ponds help alleviate poverty, provide animal source food, micronutrients, and indirect income and various jobs in developing nations. This study investigated the impact of homestead pond fish farming on dietary diversity (HDDS and MDD-W), food security (HFIAS and ELCSA), income, and women's engagement. A total of 185 households were selected randomly for data collection through well-structured questionnaire interviews in the central coast of Bangladesh. HDDS revealed significant dietary diversity (73.3%) among beneficiary farmers, surpassing controls and nearly doubling that of non-aquaculture farmers (41.1%). Additionally, this study found that 86.7% and 74.3% of women in beneficiary and homestead pond farmers exhibited high dietary diversity (MDD-W ≥ 5), whereas 48.6% of women in non-aquaculture farmers' households had low dietary diversity (MDD-W ≥ 5). Based on both ELCSA and HFIAS, higher prevalence of food security was observed among the beneficiary farmers that was about 60% and 63.3%, respectively compared with the control farmers. Most non-aquaculture farmers (62.9%) indicated their family consumed fish for one week before the research. More than half of the homestead pond culture (55.7%) and more than 90% of the beneficiary farmers, aquaculture farmers and non-aquaculture farmers had gross income (<$ 500). Pertaining to women's participation in homestead pond was positively correlated to productivity while male dominated tasks was negatively correlated with productivity. The results offer insights into how homestead pond fish farming can enhance food security by supplying direct animal protein, addressing protein and micronutrient deficiencies, and boosting income. The study emphasizes the urgent necessity for training and promoting homestead pond culture, increasing female participation, and advocating comprehensive support from governmental organizations (GOs) and non-governmental organizations (NGOs) to optimize production, improve micronutrient adequacy, and guarantee household food security. Keywords: Fish farming, food security, dietary diversity, women's participation.

Candidacidal effect of fluconazole and chlorhexidine released from acrylic polymer.

OBJECTIVES: To investigate the efficacy and rate of killing of a fluconazole- or chlorhexidine-impregnated polymeric delivery system against fluconazole-susceptible and -resistant Candida albicans and fluconazole-resistant Candida glabrata. METHODS: Poly(ethyl methacrylate)/tetrahydrofurfuryl methacrylate (PEM/THFM) discs impregnated with chlorhexidine, pure fluconazole (FLCp) or fluconazole from capsules (FLCc) were prepared by substituting a portion of PEM powder with an equivalent amount of each drug. Discs were incubated in sterile water for 1, 3, 7, 14, 21 and 28 days. The amounts of drugs in the leachates were measured spectrophotometrically and their antifungal activity against fluconazole-susceptible (n=1) and fluconazole-resistant (n=2) candidal isolates was determined using a time-kill method and by comparing the released concentrations with the corresponding MICs. RESULTS: Fluconazole and chlorhexidine leached from PEM/THFM polymer for up to 28 days and the released concentrations were fungicidal against all three Candida isolates for at least the first 7 days. Chlorhexidine leachates killed all Candida isolates more rapidly than the two fluconazole formulation leachates throughout the study period. FLCc leachates required longer incubation for 100% killing than FLCp leachates. The proportion of viable C. glabrata dropped more slowly than that of C. albicans with the same MIC. CONCLUSIONS: The concentrations of chlorhexidine and fluconazole leached from the PEM/THFM polymer were fungicidal against all Candida isolates, including those resistant to fluconazole, for the first 7 days. Chlorhexidine leachates showed a rapid fungicidal activity for up to 4 weeks, which can be of use in cases with poor response to conventional antifungals.

Timing of photoperiodic competency causes phenological mismatch in balsam poplar (Populus balsamifera L.).

Plant phenology is expected to be sensitive to climate warming. In boreal trees, spring flush is primarily temperature driven, whereas height growth cessation and autumn leaf senescence are predominantly controlled by photoperiod. Cuttings of 525 genotypes from the full range of balsam poplar were planted into two common gardens (Vancouver and Indian Head, Canada) at similar latitudes, but with differing winter temperatures and growing seasons. There was clinal variation in spring and, particularly, summer and fall phenology. Bud flush and, despite milder climate, bud set and leaf drop were earlier at Vancouver than at Indian Head by 44, 28 and 7 d, respectively. Although newly flushed growth is insensitive to photoperiod, many genotypes at both sites became competent before the summer solstice. At Vancouver, high-latitude genotypes set dormant terminal buds in mid-spring. Most other genotypes grew until midsummer or set bud temporarily and then experienced a second flush. In both gardens and in a growth chamber experiment, earlier bud set was associated with reduced height growth and higher root/shoot ratios. Shoots attained competency ~5 weeks after flushing, which would normally prevent dormancy induction before the solstice, but may be insufficient if spring advances by more than a few weeks.

A search for Fabry disease among male end-stage renal disease patients in Lebanon and a review of the literature.

BACKGROUND: Fabry disease (FD) is an X-linked lysosomal storage disorder occurring from the deficiency of the enzyme alpha-galactosidase A (alpha-GalA). This deficiency causes the systemic lysosomal accumulation of glycolipids, mainly globotriosylceramide (GL-3) resulting in progressive and multisystem involvement and complications. End-stage renal disease (ESRD) is responsible for significant morbidity and mortality among patients with FD. In the absence of any report about FD from Lebanon, this study was warranted to attempt revealing the prevalence of this disease among hemodialysis (HD) patients in this country. METHODS: A screening was carried out on 275 male Lebanese HD patients from five dialysis centers across Lebanon. The patients included in the study were male HD patients > 18 years of age. They all consented to participate. The alpha-GalA activity was determined from the patients' plasma in Universitatskilinikum, Hamburgeppendorf, Metabolic laboratory, Hamburg, Germany. RESULTS: None of the 275 patients enrolled in the study have shown a decrease in alpha-galactosidase activity below 13 nmol/hr/ml of plasma. This indicates the absence of FD in this study population. CONCLUSION: Though no FD was detected among HD patients in this country so far, awareness about FD and its related complications in the general population and among physicians should be maintained. Once a patient is diagnosed with FD, examining other members in the family of affected patients is warranted.

Alteration of cell cytoskeleton and functions of cell recovery of normal human osteoblast cells caused by factors associated with real space flight.

Experiments involving short-term space flight have shown an adverse effect on the physiology, morphology and functions of cells investigated. The causes for this effect on cells are: microgravity, temperature fluctuations, mechanical stress, hypergravity, nutrient restriction and others. However, the extent to which these adverse effects can be repaired by short-term space flown cells when recultured in conditions of normal gravity remains unclear. Therefore this study aimed to investigate the effect of short-term spaceflight on cytoskeleton distribution and recovery of cell functions of normal human osteoblast cells. The ultrastructure was evaluated using ESEM. Fluorescent staining was done using Hoechst, Mito Tracker CMXRos and Tubulin Tracker Green for cytoskeleton. Gene expression of cell functions was quantified using qPCR. As a result, recovered cells did not show any apoptotic markers when compared with control. Tubulin volume density (p<0.001) was decreased significantly when compared to control, while mitochondria volume density was insignificantly elevated. Gene expression for IL-6 (p<0.05) and sVCAM-1 (p<0.001) was significantly decreased while alkaline phosphatase (p<0.001), osteocalcin and sICAM (p<0.05) were significantly increased in the recovered cells compared to the control ones. The changes in gene and protein expression of collagen 1A, osteonectin, osteoprotegerin and beta-actin, caused by short-term spaceflight, were statistically not significant. These data indicate that short term space flight causes morphological changes in osteoblast cells which are consistent with hypertrophy, reduced cell differentiation and increased release of monocyte attracting proteins. The long-term effect of these changes on bone density and remodeling requires more detailed studies.

Diaporthe sp. F18; a new source of camptothecin-producing endophytic fungus from Nothapodytes nimmoniana growing in Sri Lanka.

An endophytic fungus producing camptothecin (CPT) was isolated from the leaf of Nothapodytes nimmoniana (Sri Lanka), and culture conditions were optimised to enhance the yield of CPT. The TLC, HPLC-PDA, LC-MS/MS and spectroscopic data were used to identify and quantify CPT. Solvent extraction (chloroform: methanol 4:1 v/v) of submerged cultures in Sabouraud Dextrose Broth (SDB) detected CPT in the mycelial extract but not in the culture broth. The fungus was (KX212080) closely related to Diaporthe guangxiensis (MK335772) with 99% sequence similarity, thus tentatively identified as Diaporthe sp. F18. A significantly high CPT content (72.0 ± 0.2 µg/g) was produced in SDB, pH, 5.6 incubated at 30 °C under shake flask condition (150 rpm) for 14 days. Tryptophan significantly (p > 0.05) enhanced CPT production while ethanol increased it by 8-fold. This endophytic source produced higher CPT content than what has been reported hitherto in the literature, with fairly stable production up to sixth subculture generations.

Innovations in ventricular tachycardia ablation.

Catheter ablation of ventricular arrhythmias (VAs) has evolved significantly over the past decade and is currently a well-established therapeutic option. Technological advances and improved understanding of VA mechanisms have led to tremendous innovations in VA ablation. The purpose of this review article is to provide an overview of current innovations in VA ablation. Mapping techniques, such as ultra-high density mapping, isochronal late activation mapping, and ripple mapping, have provided improved arrhythmogenic substrate delineation and potential procedural success while limiting duration of ablation procedure and potential hemodynamic compromise. Besides, more advanced mapping and ablation techniques such as epicardial and intramyocardial ablation approaches have allowed operators to more precisely target arrhythmogenic substrate. Moreover, advances in alternate energy sources, such as electroporation, as well as stereotactic radiation therapy have been proposed to be effective and safe. New catheters, such as the lattice and the saline-enhanced radiofrequency catheters, have been designed to provide deeper and more durable tissue ablation lesions compared to conventional catheters. Contact force optimization and baseline impedance modulation are important tools to optimize VT radiofrequency ablation and improve procedural success. Furthermore, advances in cardiac imaging, specifically cardiac MRI, have great potential in identifying arrhythmogenic substrate and evaluating ablation success. Overall, VA ablation has undergone significant advances over the past years. Innovations in VA mapping techniques, alternate energy source, new catheters, and utilization of cardiac imaging have great potential to improve overall procedural safety, hemodynamic stability, and procedural success.