Gender Dimorphism of Skeletal Measurements and Dental Angle Classification in Orthodontic Patients.

AIM: The present study aimed to evaluate gender dimorphism of the skeletal and dental angles and measurements among different types of malocclusions in the Population of Jizan, Kingdom of Saudi Arabia (KSA). MATERIALS AND METHODS: Cephalometric data were retrieved from the archived records of 272 dental patients, comprising 134 males and 138 females. Skeletal and dental malocclusions in both the sub-groups were digitally studied. STATISTICAL ANALYSIS: The measurement reliability was assessed using the intra-class correlation coefficient (ICC). Non-parametric Mann-Whitney U tests were performed to evaluate the difference in skeletal and dental parameters between genders. The Chi-square test was done to determine the difference in malocclusion patterns amongst the gender. RESULTS: Statistical significance was noted in dental malocclusion (p-value = 0.003) and facial height, with females having a steeper mandible plan than males. The Sella-nasion-Nasion-Vertical line angles were reported high in females with no statistical significance. Linear cephalometric values were measured higher in males than females, whereas angular values and facial height parameters were lower in females than male. CONCLUSION: Within the limitation of this study, it could be concluded that there is a prominent difference measured in facial profiles of males and females with higher facial height in males. Clinical significance and limitations: These clinical outcomes will help orthodontists to analyze the accurate base angles and points to draft proper treatment plans considering the variation in the profile of males and females.

The Effect of Topical Application of Hyaluronic Acid on the Stability of Immediate Loaded Dental Implants in the Posterior Maxilla: Clinical and Animal Study.

Objective: To assess the effect of topically applied hyaluronic acid (HA) on the stability of immediately loaded implants in the posterior maxilla. Materials and Methods: For the clinical study, a total of 20 implants were placed in 14 patients seeking the replacement of missing single or multiple posterior maxillary teeth. The patients were randomly divided into two groups. In the clinical control group (CC group), 10 implants were placed and immediately loaded, while in the clinical study group (CS group), 10 implants were coated with HA immediately before placement and immediately loaded. All patients had implant stability clinically evaluated at implant placement time (T0) and 1 (T1), 3 (T3), and 6 (T6) months after loading. Peri-implant pocket depth and modified sulcus bleeding index were evaluated clinically at 6 months in all patients. Bone density was evaluated radiographically after 3 months. All the clinical and radiographic data were subjected to statistical analysis. For the animal study, a total of 12 implants were placed in the tibiae of six rabbits. For each rabbit, 1 implant without any applied HA was placed in the left tibia (AC group), and 1 implant coated with HA was placed in the right tibia (AS group). The rabbits were euthanized at 21 and 45 days after implant insertion. Results: There were no significant statistical differences between the two groups regarding implant stability, peri-implant pocket depth, modified sulcus bleeding index, or bone density from the palatal and apical aspects. However, there was a significant statistical difference in the bone density from the buccal aspect in favor of the study group. The animal study showed that the newly formed bone in the right tibiae showed improved quantity and quality of bone, as it had denser bone trabeculae and smaller marrow spaces compared to the left tibiae. Conclusion: In the clinical study, the application of hyaluronic acid had a superior effect on the buccal bone density around immediately loaded implants. In the animal study, hyaluronic acid had a synergistic effect on the quality and quantity of bone formation around dental implants.

Retear bigger than preoperative tear size would lead to treatment failure after rotator cuff repair.

BACKGROUND: This study aimed to (1) define treatment failure using the referred patient acceptable symptomatic state (PASS) values for pain visual analog scale (PVAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and Single Assessment Numeric Evaluation (SANE) clinical scores and (2) identify the factors that lead to patient dissatisfaction after arthroscopic rotator cuff repair (ARCR). METHODS: We analyzed the arthroscopic rotator cuff surgery registry data from January 2015 to December 2016. Patients were followed for ≥2 years and categorized as dissatisfied or satisfied based on our own definition of treatment failure at 2 years postoperatively. For defining treatment failure, the referred PASS values for the PVAS, ASES, and SANE scores were used. Patients who failed to attain the PASS value for the PVAS, ASES, or SANE score were categorized into the dissatisfied group. Pre- and postoperative imaging and basic demographic data were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify the factors affecting patient satisfaction at 2 years after rotator cuff repair. RESULTS: Of 117 patients, 30 (25.6%) were defined as the dissatisfied group (mean follow-up period, 37.5 months). Seventeen patients (14.5%) had confirmed retear on follow-up magnetic resonance imaging. In the univariate analysis, sex significantly differed between the groups (female, satisfied vs. dissatisfied groups: 39 [44.8%] vs. 22 [73.3%]; P = .010). Retear alone did not affect patient satisfaction in the univariate analysis (P = .11). Progressed retear size featured a significantly higher risk of patient dissatisfaction (P = .024; odds ratio 6.430, 95% confidence interval 1.270-32.541) in the multivariable analysis using symptom duration, sex, preoperative ASES score, preoperative tear size, retear, and progressed retear size as variables. Moreover, female sex had an increased odds for dissatisfaction (odds ratio 4.646, 95% confidence interval 1.590-13.578; P = .005). CONCLUSION: Two years after ARCR, most patients (74.4%) reported satisfaction with their outcomes. However, satisfaction levels can be altered by female sex or progressed retear size compared with the preoperative state.

Do Nonsteroidal Anti-Inflammatory or COX-2 Inhibitor Drugs Increase the Nonunion or Delayed Union Rates After Fracture Surgery?: A Propensity-Score-Matched Study.

BACKGROUND: The effects of nonsteroidal anti-inflammatory drugs (NSAIDs)/cyclooxygenase (COX)-2 inhibitors on postoperative fracture-healing are controversial. Thus, we investigated the association between NSAID/COX-2 inhibitor administration and postoperative nonunion or delayed union of fractures. We aimed to determine the effects of NSAID/COX-2 inhibitor administration on postoperative fracture-healing with use of a common data model. METHODS: Patients who underwent operative treatment of a fracture between 1998 and 2018 were included. To determine the effects of NSAID/COX-2 inhibitor administration on fracture-healing, postoperative NSAID/COX-2 inhibitor users were compared and 1:1 matched to nonusers, with 3,264 patients matched. The effect of each agent on bone-healing was determined on the basis of the primary outcome (nonunion/delayed union), defined as having a diagnosis code for nonunion or delayed union ≥6 months after surgery. The secondary outcome was reoperation for nonunion/delayed union. To examine the effect of NSAIDs/COX-2 inhibitors on bone union according to medication duration, a Kaplan-Meier survival analysis was performed. RESULTS: Of the 8,693 patients who were included in the analysis, 208 had nonunion (178 patients; 2.05%) or delayed union (30 patients; 0.35%). Sixty-four (30.8%) of those 208 patients had a reoperation for nonunion or delayed union. NSAID users showed a significantly lower hazard of nonunion compared with the matched cohort of nonusers (hazard ratio, 0.69 [95% confidence interval, 0.48 to 0.98]; p = 0.040) but did not show a significant difference in the other matched comparison for any other outcomes. Kaplan-Meier survival analysis revealed significantly lower and higher nonunion/delayed union rates when the medication durations were ≤3 and >3 weeks, respectively (p = 0.001). For COX-2 inhibitors, the survival curve according to the medication duration showed no significant difference among the groups (p = 0.9). CONCLUSIONS: Our study demonstrated no short-term impact of NSAIDs/COX-2 inhibitors on long-bone fracture-healing. However, continued use of these medications for a period of >3 weeks may be associated with higher rates of nonunion or delayed union. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Is sickle cell disease a risk factor for severe COVID-19 outcomes in hospitalized patients? A multicenter national retrospective cohort study.

Introduction: Studies that examine the association between sickle cell disease (SCD) and COVID-19 outcomes are lacking. This study aims to determine whether SCD is a risk factor for severe COVID-19 infection in regard to the requirement of noninvasive ventilation/high flow nasal cannula (NIV/HFNC), mechanical ventilation (MV), or death in hospitalized patients. Methods: Retrospective cohort study included COVID-19 patients admitted to four COVID-19 treatment facilities in Bahrain between February 24, 2020 and July 31, 2020. All SCD patients with COVID-19 were included and compared to a randomly selected sample of non-SCD patients with COVID-19. Data were collected from the medical records. Multivariate logistic regression models were used to control for confounders and estimate the effect of SCD on the outcomes. Results: 1792 patients with COVID-19 were included; 38 of whom were diagnosed with SCD as well. In the SCD group, one (2.6%) patient required NIV/HFNC, one (2.6%) required MV, and one (2.6%) death occurred. In comparison, 56 (3.2%) of the non-SCD patients required NIV/HFNC, 47 (2.7%) required MV, and death occurred in 58 (3.3%) patients. Upon adjusting for confounders, SCD had an odds ratio of 1.847 (95% CI: 0.39-8.83; p = 0.442). Conclusion: Our results indicate that SCD is not a risk factor for worse COVID-19 outcomes in hospitalized patients.

Role of Additional Inferomedial Supporting Screws in Osteoporotic 3-Part Proximal Humerus Fracture: Finite Element Analysis.

INTRODUCTION: Importance of inferomedial supporting screws in preventing varus collapse has been investigated for the proximal humerus fracture. However, few studies reported the results of osteoporotic complex fracture. This study aimed to demonstrate the stress distribution pattern, particularly in osteoporotic 3-part proximal humerus fractures involving greater tuberosity (GT) with different screw configurations. MATERIALS AND METHODS: Using the computed tomography (CT) images of 2 patients, who had osteoporosis and the other had normal bone density, 3-part fractures involving the GT, without medial support were reconstructed. To reflect the osteoporosis or real bone density, Hounsfield unit of CT scans were utilized. A force of 200 N was applied in 30° varus direction. The proximal screws were set in 2 ways: 6 screws without inferomedial supporting screws and 9 screws with inferomedial supporting screws. Qualitative and quantitative analysis of internal stress distribution were performed. RESULTS: The most proximal part area near humeral head vertex and near the 1st screw's passage and tip had more stress concentrated in osteoporotic 3-part fractures. The stress distribution around the proximal screws was found near the GT fracture line and its lateral side, where the local max values located. Inferomedial supporting screws decreased these effects by changing the points to medial side from the GT. The ratio in osteoporotic bone model decreased to that in normal bone model when inferomedial supporting screws were applied (normal bone, 2.97%-1.30%; osteoporosis bone, 4.76%-1.71%). CONCLUSIONS: In osteoporotic 3-part proximal humerus fracture, the stress distribution was concentrated on the area near the humeral vertex, 1st row screw tips, and lateral side region from the GT fracture line. Moreover, inferomedial supporting screws ensured that the stress distribution is similar to that in normal bone setting, particularly in osteoporotic condition.

WITHDRAWN: A novel robust adaptive sliding mode control using fuzzy self-tuning PID controller for 3 DOF planar robot manipulators.

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