Unraveling the challenges in the diagnosis and management of desmoplastic fibroma of the mandible-a case report.

Desmoplastic fibroma (DF) is an uncommon bone tumor that originates from the mesenchymal tissue and despite being benign, exhibits aggressive behavior locally. The following report describes the case of a 7-year-old boy with a rapidly enlarging swelling on the right side of the mandible. After a thorough clinical examination, radiographic imaging, and histopathological analysis, the diagnosis of DF was confirmed. Treatment planning was formulated considering both the tumor's tendency for local recurrence and the patient's well-being. Due to the patient's young age, segmental resection was not deemed appropriate, and an aggressive curettage and enucleation of the lesion followed by the bone graft was performed instead. The patient was kept under close follow-up for the first month of post-surgery and later reviewed after 3, 6, 9, and 12 months, respectively. Good bone healing was observed on radiographs. The patient did not show any signs of recurrence based on clinical or radiographic assessments and did not exhibit any neurosensory deficits as well.

An Analysis of Shoulder Surgeon Volume on Surgeon Competency, Hospital Costs, and Adverse Events: A Systematic Review.

Purpose: The purpose of this systematic review is to assess the impact of shoulder surgeon volume of common shoulder procedures on hospital/surgeon efficiency, adverse events, and hospital costs. Methods: Four online databases (PubMed, Embase, MEDLINE, and CENTRAL) were searched for literature on the influence of surgeon volume on outcomes for shoulder surgery, from data inception to October 1, 2020. The Methodological Index for Non-Randomized Studies tool was used to assess study quality. Data are presented descriptively. Results: Twelve studies encompassing 150,898 patients were included in this review. The distribution of surgery type was rotator cuff repair (53.7%; n = 81,066), shoulder arthroplasty (35.7%; n = 53,833), and ORIF (10.6%; n = 15,999). Higher surgeon volume for rotator cuff repairs was associated with lower surgical time, length of stay, costs, and reoperation/readmission rates. For shoulder arthroplasty, higher surgeon volume was associated with lower length of stay, costs, surgical time, non-routine disposition, blood loss, reoperation/readmission, and complications. As for ORIF, higher surgeon volume was associated with lower length of stay, costs, and complications. Conclusion: A high surgical volume leads to improved results for hospital/surgeon efficiency and reduces adverse events and hospital costs across various orthopaedic procedures. Hospitals and physicians can use this information to develop and adhere to policies and practices that contribute to more efficient and better-quality care for patients. Level of Evidence: III.

Epithelial Cell Adhesion Molecule (EpCAM) Expression Can Be Modulated via NFκB.

The epithelial cell adhesion molecule (EpCAM) is considered an essential proliferation signature in cancer. In the current research study, qPCR induced expression of EpCAM was noted in acute lymphoblastic leukemia (ALL) cases. Costunolide, a sesquiterpene lactone found in crepe ginger and lettuce, is a medicinal herb with anticancer properties. Expression of EpCAM and its downstream target genes (Myc and TERT) wasdownregulated upon treatment with costunolide in Jurkat cells. A significant change in the telomere length of Jurkat cells was not noted at 72 h of costunolide treatment. An in silico study revealed hydrophobic interactions between EpCAM extracellular domain and Myc bHLH with costunolide. Reduced expression of NFκB, a transcription factor of EpCAM, Myc, and TERT in costunolide-treated Jurkat cells, suggested that costunolide inhibits gene expression by targeting NFκB and its downstream targets. Overall, the study proposes that costunolide could be a promising therapeutic biomolecule for leukemia.

Next Wave of Targets in the Treatment of Advanced Renal Cell Carcinoma.

While surgical resection has remained the mainstay of treatment in early-stage renal cell carcinoma (RCC), therapeutic options in the advanced setting have remarkably expanded over the last 20 years. Tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptor (VEGF-TKIs) and anti-programmed cell death 1 (PD-1)/anti-programmed death-ligand 1 (PD-L1)-based immune checkpoint inhibitors (ICIs) have become globally accepted options in the upfront metastatic setting, with different ICI-based combination strategies improving overall survival compared to single-agent Sunitinib. Although some patients benefit from long-term responses, most eventually develop disease progression. Ongoing efforts to better understand the biology of RCC and the different mechanisms of acquired resistance have led to the identification of promising therapeutic targets. Belzutifan, a novel agent targeting the angiogenic pathway involving hypoxia-inducible factors (HIFs), has already been approved for the treatment of early-stage tumors associated with VHL disease and represents a very promising therapy in advanced RCC. Other putative targets include epigenetic regulation enzymes, as well as several metabolites such as adenosine, glutaminase and tryptophan, which are critical players in cancer cell metabolism and in the tumor microenvironment. Different methods of immune regulation are also being investigated, including CAR-T cell therapy and modulation of the gut microbiome, in addition to novel agents targeting the interleukin-2 (IL-2) pathway. This review aims to highlight the emergent novel therapies for RCC and their respective completed and ongoing clinical trials.

Association between obesity and periodontitis in Australian adults: A single mediation analysis.

BACKGROUND: Obesity and periodontitis are conditions with high burden and cost. This study aims to unfold the proposed pathways through which the effect of obesity in the presence of health behaviors (dental visiting behavior and diabetes) increases the risk of periodontitis? METHODS: The effect decomposition analysis using potential outcome approach was used to determine obesity-related periodontitis risk using the Australian National Survey of Adult Oral Health 2004 to 2006. A single mediation analysis for exposure, "physical-inactivity induced obesity," mediator "dental visiting behavior (a de facto measure of healthy behaviors)," outcome "periodontitis," and confounders "age, sex, household income, level of education, self-reported diabetes, alcohol-intake and smoking," was constructed for subset of 3,715 participants, aged ≥30 years. Proposed pathways were set independently for each risk factor and in synergy. The STATA 15 Paramed library was used for analysis. Sensitivity analysis was conducted to detect unmeasured confounding using non-parametric approach. RESULTS: The average treatment effect of physical inactivity induced obesity to periodontitis is 14%. Pathway effect analysis using potential outcomes illustrated that the effect of obesity on periodontitis that was not mediated through poor dental visiting behavior was 10%. Indirect effect of obesity-mediated through poor dental visiting behavior on periodontitis was 3%. CONCLUSIONS: The direct effect of physical inactivity induced obesity on periodontitis was higher than the indirect effect of obesity on periodontitis through dental visiting behavior. Establishing a pathway of causal relationship for obesity and periodontitis could help in developing management strategies that focuses on mediators.

Freeman-Sheldon Syndrome with Stiff Knee Gait - A Case Report.

Introduction: Freeman-Sheldon syndrome (FSS), also known as the distal arthrogryposis (DA) type 2A, is a rare congenital anomaly. We report a unique case of the DA type 2A with mixed clinical features and the unusual presentation of bilateral congenital dislocation of the knee but had unassisted stiff knee gait. Case Report: A 5-year-old female child presented to the clinic with the complaint of inability to bend both knees since birth. She had an unassisted bipedal gait, but could not squat, cross-leg sit, run, and climb stairs without assistance. Her youngest brother had a similar presentation but succumbed to death at the age of 5 months due to respiratory distress. Clinical features were in the favor of FSS. Her serum creatinine kinase level was normal and the electromyography of bilateral tibialis anterior and abductor pollicis brevis was not suggestive of the myotonia. Radiograph of the skull showed cooper beaten skull appearance whereas bilateral pelvis with the hip showed following changes in the right hip; decrease femoral epiphysis height, horizontal proximal femoral physis, and the coxa brevia. She was initially managed conservatively by weekly stretching, manipulation, and casting. As a result, she could flex her knee up to 20°. Although the quadricepsplasty might be helpful for the persistent extension deformity, there was marked quadriceps weakness which could make it harder for the child to stand and walk. In addition, the abnormal muscle physiology in FSS may result in unfavorable outcomes after the surgery. Moreover, a consideration of the surgical aspect is not free of risks which include difficult endotracheal intubation, vein access, and malignant hyperthermia. Conclusion: FSS is a rare congenital anomaly that should be differentiated from another syndrome of the close resemblance, Sheldon Hall syndrome and Schwartz Jampel syndrome which are other rare autosomal recessive disorders characterized by myotonia and the chondrodysplasia. Conservative management has still a role in bilateral knee involvement especially if the patient is an independent walker.

Obesity and periodontitis in Australian adults: A population-based cross-sectional study.

OBJECTIVES: Obesity and periodontitis are public health issues in Australia. This study aimed to determine the association between overweight/obesity and periodontitis in Australian adults. MATERIALS AND METHODS: The cross-sectional National Survey of Adult Oral Health 2004-2006 data were analysed. Body mass index was calculated, and a self-reported questionnaire was used to measure the estimated daily intake of added sugar. The mean number of sites with probing depth (PD) ≥ 4 mm and clinical attachment loss (CAL) ≥ 4 mm and presence of periodontitis were used as outcome measures. CDC/AAP periodontitis case definition was adopted. Bivariate analyses and multiple variable regression models were constructed. RESULTS: The study sample was 4,170 participants. The proportion of people that were overweight/obese was 51.9% [95% confidence interval (CI): 48.1%, 54.1%]. Overall 21.3% (95% CI: 19.3%, 23.5%) people experienced periodontitis. The mean number of sites with PD ≥ 4 mm and CAL ≥ 4 mm were recorded as 0.7 (95% CI: 0.5, 0.9) and 2.4 (95% CI: 2.1, 2.6), respectively. Multiple variable analysis suggested that periodontal parameters [sites with PD ≥ 4 mm (0.13, 95% CI: -0.86, 0.35) and sites with CAL ≥ 4 mm (0.11, 95% CI: -0.58, 0.35) and presence of periodontitis (1.23, 95% CI: 0.96, 1.57)] were not associated with overweight/obesity when controlled for putative confounders. CONCLUSION: A positive association was found between overweight/obesity and periodontitis (PD and CAL). However, the statistical significance disappeared in the multiple variable regression analysis, where age, sex, smoking and dental visiting behaviour were found to be key determinants of periodontitis.

Obesity, dietary sugar and dental caries in Australian adults.

OBJECTIVES: To determine the association of overweight/obesity, dental caries and dietary sugars in Australian adults. MATERIALS AND METHODS: The National Survey of Adult Oral Health (NSAOH) 2004-2006 provided data for analysis of dental caries experience. Self-reported body weight and height were used to calculate body mass index (BMI) for a subsample (n = 3,745, 89.8%) of the NSAOH data. A self-report questionnaire of 13 food items estimated the daily intake of added sugar, total sugars and total carbohydrate, using food composition estimates from the AUSNUT2011-2013. Bivariate analyses (Pearson's Chi-square with Rao-Scott adjustment and Student's t-tests) were used to determine the association of overweight/obesity, dental caries, sugar variables and putative confounders. Poisson regression models for the Decayed, Missing and Filled Teeth Index and individual measures of decayed, missing and filled teeth were constructed, with models containing BMI, dietary added sugar, total sugar and total carbohydrate, controlling for putative confounders. RESULTS: There was a positive association between dental caries experience and being overweight or obese compared with having normal weight or being underweight as well as between sugar consumption with all four dental caries outcome measures. When controlled for putative confounders where sugar consumption was identified as a key determinant, the statistical significance between dental caries experience and being overweight or obese disappeared. The demographic and socioeconomic factors associated with dental caries experience were age, sex, education, smoking status and usual reason for dental visit. CONCLUSION: Analysis of the relationship between dental caries and obesity must include data about sugar and carbohydrate consumption.

Dental conditions associated with preventable hospital admissions in Australia: a systematic literature review.

BACKGROUND: Over the past two decades, there has been a decrease in dental diseases in Australia; however, the number of preventable dental hospital admissions has not diminished. This review reports on the factors associated with preventable dental hospital admissions in Australia. METHODS: A search of five databases was conducted using Medical subject headings/Emtree terms and Index terms. All original studies, published between January1965 and March 2018 in English, based on the Australian population, and examining the prevalence of oral conditions as a cause for emergency department presentations and hospital admissions were included. The mixed method appraisal tool was used to evaluate the included studies. RESULTS: Eleven cross-sectional studies met inclusion and exclusion criteria. All the studies, except one from Tasmania, were from Western Australia. The most common reasons for preventable dental hospital admissions were dental caries, followed by embedded or impacted teeth. Malignant neoplasms were reported as main causes of preventable dental hospital admissions in the older population. CONCLUSIONS: Most studies on preventable dental hospital admissions were from one Australian state (Western Australia). Further research is required to determine the national prevalence and incidence of preventable dental hospital admissions. A periodic audit of preventable dental hospital admission data is needed for delivery of a fair and effective dental services.

Oral and pharyngeal cancer risk associated with occupational carcinogenic substances: Systematic review.

BACKGROUND: Oral and pharyngeal cancers (OPC) represent the seventh most common type of cancer and the seventh leading cause of deaths by cancer worldwide. Few studies have assessed the occupational exposure risks associated with OPC and in many cases the results are conflicting. The aim of this study was to determine, through a systematic review, the association of OPC and exposure to different occupational carcinogenic substances. METHODS: The addressed focused question was "Is there an association of occupational carcinogenic substances with OPC?" PubMed, MEDLINE, EMBASE, and ISI Web of Science databases were searched between January 1995 up to and including July 2016 using the keywords "oral cancer," "pharyngeal cancer," "pharyngeal neoplasms," "oral neoplasms," "occupational disease," "occupational exposure," and "occupational risk factor" in various combinations. Letters to the Editor, review articles, case reports, and unpublished articles were excluded. RESULTS: Fourteen original articles were included. Majority of the studies were conducted in European countries and used a case-control design. The results showed a significant association between formaldehyde, wood dust, coal dust, asbestos, welding fumes, and risk of developing OPC, while marginal association was observed with metal and leather dust. No associated risk was observed for textile fibers. CONCLUSION: There is some evidence to suggest associations of occupational substances with OPC, particularly in the pharynx. Future well-designed studies are required to confirm or rule out with confidence the associated exposure risk of these substances.

Accomplishments and challenges in tobacco control endeavors - Report from the Gulf Cooperation Council countries.

OBJECTIVES: To review the tobacco governance and national responsibility for control, and existing countering measures to reduce the tobacco use among the Gulf Cooperation Council (GCC) member states. METHODS: We reviewed the data in regards to tobacco control efforts and difficulties encountered during implementation of the policies for all the GCC member states from the respective country profile in the WHO report on the global tobacco epidemic. Also, we utilized the measures outlined in the FCTC's MPOWER package to not only assess the degree of national commitment, but also compare it against the level of significance that the legislatures give to this matter. RESULTS: We observed that there have been genuine advancements towards tobacco control in the GCC member states over the past few years. All the countries except Bahrain have national offices committed to tobacco control and 5 nations (excluding Oman) have dedicated support services for smoking cessation accessible to the general public. Similarly, majority of the member states have implemented a national-level ban on tobacco advertisement through national media cells as well as free dissemination of marketing material. CONCLUSION: Application and implementation of measures outline in the MPOWER package, formulation and enforcement of sturdy laws on tobacco control, and development of infrastructure and trained workforce are fundamental to manage and reinforce tobacco control measures in the GCC region.

Chronic periodontitis and smoking. Prevalence and dose-response relationship.

OBJECTIVES: To determine the prevalence and dose-response relationship of chronic periodontitis among smokers in Pakistan. METHODS:   This is a cross-sectional study among participants seeking dental care in Karachi Medical and Dental College, Karachi, Pakistan. A total of 443 participants with a mean age of 44.3 (±6.5) participated in the study from April 2011 to December 2011. Males comprised 64.7%, and females comprised 35.2%. Participants were interviewed on social demographics and oral habits. Participants with shallow pockets (3.5-5.5 mm) and deep pockets (greater than 5.5 mm) were considered suffering from chronic periodontitis. The characteristics of participants were assessed using frequency distribution for categorical variables and mean (standard deviation) for continuous variables.  RESULTS: Among 443 participants, smokers were distributed as 55.1% and non-smokers as 44.9%. Smoking was found to be significantly related to young adults (p less than 0.007), male gender (p less than 0.001), and lower education level (p less than 0.01). Overall prevalence of chronic periodontitis among smokers was estimated at 81.6%. Heavy smoking was found to have significantly high prevalence (p less than 0.001) and severity (p less than 0.001) of periodontitis as compared with moderate and light smokers. The multivariate unadjusted model depicted 3.5 times higher risk of chronic periodontitis among smokers (p less than 0.001). CONCLUSION: Chronic periodontitis had a high prevalence among smokers. Heavy smoking was found to have a higher risk for having periodontitis.

Prevalence of chronic periodontitis in an obese population: a preliminary study.

BACKGROUND: Chronic periodontitis (CP) is a global public health issue. Studies have suggested CP could be linked to obesity due to their similar pathophysiological pathway. The aim of this study is to determine the prevalence of CP and to assess the predictors for CP among the obese Malaysian population. METHODS: This is a cross-sectional study on obese participants. Obesity is defined as an individual who has Body Mass Index (BMI) ≥ 27.5 kg/m(2). A convenience sampling method was used. A total of 165 paricipants were recruited. This study involved answering questionnaires, obtaining biometric and clinical measurements of Visible plaque index (VPI), Gingival bleeding index (GBI), Probing pocket depth (PPD) and Clinical attachment loss (CAL). Data analysis was carried out using SPSS statistical software (SPSS Inc., version 20, US). RESULTS: A total of 165 participants; 67 (40.6%) males and 98 (59.4%) females participated in the study. Mean age of the participants was 43.9 (± 8.9). The prevalence of CP among the obese population was found to be 73.9%. Out of this, 43 and 55% were categorised as moderate and severe CP respectively. Around 64% of participants had sites with CAL ≥ 4 mm and participants with sites with PPD ≥ 4 mm were reported to be 25%. Around 83% of the participants had sites with GBI ≥ 30 and 92% of participants had sites with VPI ≥ 20%. GBI and VPI were found to have significantly higher odds for CP. CONCLUSION: Prevalence of CP was high among obese Malaysians. GBI and VPI were potential predictors for CP in this obese population.