Morphological and Dimensional Analysis of the Nasopalatine Canal: Insights from Cone-Beam Computed Tomography Imaging in a Large Cohort.

BACKGROUND The nasopalatine canal (NPC), or incisive canal, is located in the midline of the palate, posterior to the maxillary central incisors. Its anatomy is important in prosthetic dentistry procedures. This study aimed to assess the anatomical morphology of the NPC according to age, sex, and dental status using cone-beam computed tomography (CBCT) in 335 patients. MATERIAL AND METHODS In this retrospective cross-sectional study, a total of 335 patients were recruited and categorized according to sex, age, and dental status. Individual CBCT images were analyzed in the sagittal, coronal, and axial planes. Also, we recorded the dimensions and morphological shape of the NPC and adjacent buccal bone plate (BBP) under standardized conditions. The associations between sex, age group, NPC shapes and types, and presence of central incisors were assessed. A significance level was set at P<0.05. RESULTS Mean labio-palatal and mediolateral measurements of the incisive foramen were 5.13±1.45 mm and 3.21±0.96 mm, whereas the mean diameter of Stenson foramen was 2.57±1.25 mm, and the total length of the NPC was 11.79±2.50 mm. Funnel, Y, and round-shaped canals were the most prevalent shapes of the NPC in sagittal, coronal, and axial planes. BBP was greater in men, with P=0.011, P=0.000, and P=0.001 at BBP1, BBP2, and BBP3, respectively. CONCLUSIONS NPC and BBP parameter values were slightly higher among male patients. NPC parameters increased with older age. The crest width of BBP decreased with older age and after missing maxillary central incisor teeth.

Outcomes of dual-chamber implantable cardioverter defibrillator for left bundle branch area pacing: A systematic review of literature.

OBJECTIVE: This systematic review of literature aimed to evaluate the safety and efficacy of dual-chamber ICDs for LBBAP in patients with left bundle branch block (LBBB). METHODS: Digital databases were searched systematically to identify studies reporting the left bundle branch area pacing (LBBAP) with implantable cardioverter defibrillator (ICD) placement in patients with LBBB. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of cases, age, gender, and baseline characteristics were abstracted. RESULTS: In a total of three studies, 34 patients were included in this review. There was a significant improvement reported in QRS duration in all studies. The mean QRS duration at baseline was 170 ± 17.4 ms, whereas the follow-up QRS duration at follow-up was 121 ± 17.3 ms. Two studies reported a significant improvement of 50% in LVEF from baseline. No lead-related complications or arrhythmic events were recorded in any study. The findings of the systematic review suggest that dual-chamber ICD for LBBAP is a promising intervention for patients with heart conditions. CONCLUSION: The procedure offers significant improvements in QRS duration and LVEF, and there were no lead-related complications or arrhythmic events recorded in any of the studies.

Bibliographic analysis and evaluation of the mesh keywords in the journal of prosthodontics: Implant, esthetic, and reconstructive dentistry.

BACKGROUND: Various studies have been conducted to analyze data via bibliometric analysis in different dentistry, including prosthetic dentistry. However, these studies evaluated the most cited published articles in dentistry. OBJECTIVE: To analyze and evaluate the characteristic development of several mesh keywords in the Journal of Prosthodontics - Implant, Esthetic, and Reconstructive Dentistry between 1992 and 2022. METHODS: The Scopus databases was searched to retrieve the data related to 8 categories, including published articles, most cited documents, authors and organizations, and maximum articles cited during the evaluation period. The data retrieved were exported to a Microsoft Excel sheet and were analyzed using the bibliometrix package. The data were first analyzed for ten years and then for 30 years. The highest of 10 were reported for each category, and co-authorship, reoccurrence, and linked data were also reported. RESULTS: 2603 published documents were recorded from the Scopus databases. Articles comprised 87.9% of the total published work, followed by review articles at 5.46%. The most productive decade was between 2013 and 2022. 3793 terms were used during the evaluation period, with the maximum number in 2003-2012 (2481). A total of 5392 keywords were used during 1992-2022, with the highest number (3232) from 2013 to 2022. A total of 6108 authors were acknowledged, with the maximum number (3964) from 2013 to 2022 and the fewest (767) from 1992 to 2002. Authors from different countries increased from 17 countries in 1992-2002 to 52 countries in 2013-2022 (total = 63 countries). Similarly, the number of organizations increased from 312 organizations in 1992-2002 to 1315 organizations in 2013-2022 (total = 1976 organizations). CONCLUSION: The current bibliometric analysis delivered a comprehensive overview about more spread research topics and its impactful role in contemporary dentistry, especially prosthetic dentistry.

Performance Prediction of Hybrid Bamboo-Reinforced Concrete Beams Using Gene Expression Programming for Sustainable Construction.

The building and construction industry's demand for steel reinforcement bars has increased with the rapid growth and development in the world. However, steel production contributes to harmful waste and emissions that cause environmental pollution and climate change-related problems. In light of sustainable construction practices, bamboo, a readily accessible and eco-friendly building material, is suggested as a viable replacement for steel rebars. Its cost-effectiveness, environmental sustainability, and considerable tensile strength make it a promising option. In this research, hybrid beams underwent analysis through the use of thoroughly validated finite element models (FEMs), wherein the replacement of steel rebars with bamboo was explored as an alternative reinforcement material. The standard-size beams were subjected to three-point loading using FEMs to study parameters such as the load-deflection response, energy absorption, maximum capacity, and failure patterns. Then, gene expression programming was integrated to aid in developing a more straightforward equation for predicting the flexural strength of bamboo-reinforced concrete beams. The results of this study support the conclusion that the replacement of a portion of flexural steel with bamboo in reinforced concrete beams does not have a detrimental impact on the overall load-bearing capacity and energy absorption of the structure. Furthermore, it may offer a cost-effective and feasible alternative.

Patients' characteristics and 30-day mortality for those undergoing elective surgeries during the COVID-19 pandemic in Bangladesh.

BACKGROUND: The COVID-19 pandemic has significantly impacted the surgical practice throughout the world, including elective surgical care. This study investigated the characteristics of patients undergoing elective surgery, the prevalence of COVID-19 infection, the surgical procedures performed, and 30-day mortality in general and pediatric surgical settings in selected tertiary-level hospitals in Bangladesh from November 2020 to August 2021. METHODS: This serial cross-sectional study included 264 patients scheduled for elective surgeries during the study period. All patients underwent COVID-19 real-time polymerase chain reaction (RT-PCR) testing within 24 hours before surgery. Data on age, sex, common comorbidities, surgical procedures, and 30-day mortality were collected and analyzed. Furthermore, comparisons were made between COVID-19 positive and negative patients. RESULTS: The prevalence of COVID-19 infection among patients was 10.6%. Older age, a history of major surgery within the last three months, hypertension, and diabetes mellitus were significantly associated with COVID-19 infection. All COVID-19-negative patients underwent surgery, while only 46.4% of COVID-19-positive patients underwent surgery. The most common surgical procedures were related to the digestive system, breast, and urinary system. Only one patient (0.4%) died within 30 days after surgery among the COVID-19-negative patients, whereas two patients (7.1%) died among the COVID-19-positive patients: one before surgery and one after surgery. CONCLUSIONS: This study provides valuable insights into the characteristics, burden of COVID-19 infection, and 30-day mortality of patients undergoing elective surgery in tertiary care centers in Bangladesh during the pandemic.

Influence of Haunch Geometry and Additional Steel Reinforcement on Load Carrying Capacity of Reinforced Concrete Box Culvert.

The culverts are used to safely convey water under railways, highways, and overpasses. They are utilized in drainage areas or water channels and in areas where the bearing capacity of soil is low. The design and construction of this crucial infrastructure need to be improved to meet contemporary demands of reliability and affordability. Precast reinforced box culverts are popular alternatives as they ensure strength, durability, rigidity, and economy. This research seeks to develop an effective and affordable design improvement procedure for a precast box culvert using modern numerical tools. The Finite Element Method (FEM) based approach is used in studying the effects of haunch geometry and additional steel reinforcement on the load-bearing capacity of box culverts. A conventional box culvert is analyzed to create the numerical models in the Abaqus FEM code and to investigate the load-bearing capacity of culverts with an expanded span. The outcomes of the study reveal the critical places for stress concentration as well as the location of maximum damage. It is found that haunch geometry and additional reinforcement at these critical places significantly affect the load-carrying capacity of a culvert. From the comparison of capacity curves of models with and without haunches and diagonal reinforcement, it is found that a 25% increase in load-carrying capacity is achievable with the recommended changes. The proposed design improvement technique can be employed for the cost-effective and safe design of a concrete box culvert with larger span lengths and high water-flowing capacities. The findings of this study are expected to assist practitioners in strength enhancement tasks of box culverts for increased structural stability and drainage efficiency.

Validation of arrhythmogenic right ventricular cardiomyopathy risk calculator for sudden cardiac death: a systematic review

In the context of ARVC, a systematic review of the validation of the ARVC risk score can provide insights into the accuracy and reliability of this score in identifying patients at high risk of ARVC. Digital databases were searched to identify the relevant studies using Medical Subject Headings (MeSH). A total of 8 studies were included in this systematic review. A total of 8 studies were included in this review. The review found that the sensitivity of the ARVC risk scores ranged from 80 to 95%, and the specificity ranged from 31 to 79%. The PPV was 55%, and the NPV was 88%. The ARVC score provided a C-index for a 5-year VA risk prediction of 0.84 [95% CI (0.74–0.93)] and a Harrell C-index of 0.70 (95% CI 0.65–0.75). The calibration slope was 1.01 (95% CI 0.99–1.03). ARVC score demonstrated a significant event 5-year threshold between 15 and 20% and the classical ARVC 5-years/freedom-from-VA rate was 0.76(0.66–0.89) and the non-classical form 5-years/freedom-from-VA rate was 0.58 (0.43–0.78). In conclusion, the validation of ARVC risk scores is an essential step toward improving the accuracy of ARVC diagnosis and risk stratification. Further studies are needed to establish the accuracy and reliability of ARVC risk scores and to address the limitations of the current evidence.

Helicobacter pylori and non-alcoholic fatty liver disease: Is there a relationship?

Non-alcoholic fatty liver disease (NAFLD) is distinguished by liver injury due to metabolic stress, identified by diffuse hepatocyte macrovascular fatty lesions [1]. The prevalence of NAFLD is rising yearly, with a worldwide incidence rate between 20% and 30% [2]. Complex hereditary variables, improper lipid metabolism, and insulin resistance are the key characteristics of the etiology of NAFLD [3]. The research has revealed that aberrant lipid metabolism in the liver can result in dysbacteriosis in the intestinal flora; abnormality of the flora eventually encourages lipid deposition in the liver. Additionally, there is mounting proof that NALFD is linked to abnormalities in the gut flora, particularly Helicobacter pylori (H, pylori) [4]. Gram-negative bacillus, termed H pylori, has colonized the deep layers of the gastric mucosa. [5]. The global infection rate for H pylori is about 50% or higher [6]. According to research, H pylori causes gastric cancer, gastrointestinal lymphoma, peptic ulcers, and chronic gastritis [7]. Additionally, some researchers indicate a connection between H pylori and liver cancers, diabetes, and improper lipid metabolism [8]. Some studies have discovered that infection by H pylori is one of the elements for NAFLD to progress and that getting rid of H pylori can partially stop the evolution of NAFLD [9].

Review of Modeling Techniques for Analysis and Assessment of RC Beam-Column Joints Subjected to Seismic Loads.

Beam-column connections are the most critical components of reinforced concrete (RC) structures. They serve as a load transfer path and take a significant portion of the overall shear. Joints in RC structures constructed with no seismic provisions have an insufficient capacity and ductility under lateral loading and can cause the progressive failure of the entire structure. The joint may fail in the shear prior to the connecting beam and column elements. Therefore, several modeling techniques have been devised in the past to capture the non-linear response of such joints. Modeling techniques used to capture the non-linear response of reinforced-concrete-beam-column joints range from simplified lumped plasticity models to detailed fiber-based finite element (FE) models. The macro-modeling technique for joint modeling is highly efficient in terms of the computational effort, analysis time, and computer memory requirements, and is one of the most widely used modeling techniques. The non-linear shear response of the joint panel and interface bond-slip mechanism are concentrated in zero-length linear and rotational springs while the connecting elements are modeled through elastic elements. The shear response of joint panels has also been captured through rigid panel boundary elements with rotational springs. The computational efficiency of these models is significantly high compared to continuum models, as each joint act as a separate supe-element. This paper aims to provide an up-to-date review of macro-modeling techniques for the analysis and assessment of RC-beam-column connections subjected to lateral loads. A thorough understanding of existing models is necessary for developing new mechanically adequate and computationally efficient joint models for the analysis and assessment of deficient RC connections. This paper will provide a basis for further research on the topic and will assist in the modification and optimization of existing models. As each model is critically evaluated, and their respective capabilities and limitations are explored, it should help researchers to improve and build on modeling techniques both in terms of accuracy and computational efficiency.

A rare case report of short bowel anastomosis after acute mesenteric ischaemia in Covid-19 postive patient.

Acute mesenteric ischaemia is one of the serious abdominal surgical emergency, which has got very high morbidity and mortality. During the pandemic of COVID-19, besides respiratory complications, the virus was causing venous and arterial thromboembolism that can lead to acute mesenteric ischaemia in otherwise healthy individuals. Early diagnosis and suitable surgical procedures are the key to the better outcome of this disease. Surgical resection of gangrenous gut, leaving healthy gut is an important step of this operation. Leaving less than 200 cm of small intestine leads to short bowel syndrome which has got its own complication. This case report is on a healthy COVID-19 positive patient who presented with acute mesenteric ischaemia. After surgical resection only 1.5 feet small bowel (60 cm) was left behind and anastomosis was done with healthy transverse colon. He was later managed for complications of small bowel syndrome and was discharged successfully with dietary modifications.

Effect of docosahexaenoic acid as a chemopreventive agent on experimentally induced hamster buccal pouch carcinogenesis.

PURPOSE: The current study was directed to investigate the effectiveness of docosahexaenoic acid (DHA) as a chemopreventive agent on experimentally induced hamster buccal pouch (HBP) carcinogenesis. MATERIAL AND METHODS: In this study we used 40 Syrian male hamsters, five weeks old, were divided into 4 groups (GI, GII, GIII, and GIV) of 10 animals in each as follows, GI: Topical application of liquid paraffin alone (thrice a week for 14 weeks), GII: Topical application of 7, 12 dimethyl benz[a]anthracene (DMBA) alone (0.5% in liquid paraffin, thrice a week for 14 weeks), GIII: Topical application of DMBA (0.5% in liquid paraffin, thrice a week for 14 weeks) + Oral administration of DHA (125 mg/kg b.w. in 1 ml distilled water by oral gavage, thrice a week for 14 weeks on alternative days of DMBA application), GIV: Oral administration of DHA alone (125 mg/kg b.w. in 1 ml distilled water by oral gavage, thrice a week for 14 weeks). RESULTS: Gross observations and histopathological findings revealed that, in GI: normal stratified squamous epithelium, in GII: well and moderately differentiated squamous cell carcinoma (SCC), in GIII: variable results ranges from hyperkeratosis, hyperkeratosis and focal hyperplasia, mild dysplasia, and well differentiated SCC with superficial invasion of tumor cells not extended to deeper areas, while in GIV: normal similar to GI. Immunohistochemical results indicated that oral DHA treatment to DMBA treated hamsters restored the normal expression of bcl-2. CONCLUSION: Our results indicated that DHA has the potential to be a dietary chemopreventive agent due to its capacity to improve carcinogen detoxification and to block/suppress the initiation and promotion stages of experimentally produced HBP carcinogenesis.

Roles of Proliferation and Angiogenesis in Locally Aggressive Biologic Behavior of Ameloblastoma versus Ameloblastic Fibroma.

(1) Background: The present study was carried out to evaluate the roles of proliferation and angiogenesis in locally aggressive biologic behavior of ameloblastoma versus ameloblastic fibroma; (2) Methods: 30 formalin-fixed paraffin embedded blocks (15 cases of ameloblastoma and 15 cases of ameloblastic fibroma) were used. To evaluate the proliferation, the tissue sections were stained with an AgNORs stain. CD105 was used as an immunohistochemical marker of angiogenesis. Quantitative evaluations of AgNORs were performed. The mean vascular density was evaluated as a measure for CD105 protein expression by using image analyzer computer system; (3) Results: The mean number of AgNORs dots per nucleus was significantly higher in ameloblastoma as compared to ameloblastic fibroma. Additionally, the protein level of CD105 showed positive expression and wide distribution that the mean vascular density was significantly higher in ameloblastoma as compared to ameloblastic fibroma; (4) Conclusion: Quantitative evaluation of the AgNORs stain and the mean vascular density utilizing CD105 protein expression may reflect a higher proliferative activity and a more locally aggressive biologic behavior of ameloblastoma when compared to ameloblastic fibroma, indicating that other factors may be involved in biologic behavior of ameloblastic fibroma.

Aortic-Valve Sparing Repair and Homograft and Dacron Pulmonary Reconstruction Long-term After Arterial Switch Operation.

The arterial switch operation is the gold-standard treatment for dextro-transposition of the great arteries. Long-term follow-up data are beginning to reveal its natural history and associated late complications, including various reoperations for those complications. Given the unique anatomy and the increasing longevity of these patients, there is a need for effective surgical repair options to address aneurysmal and degenerative changes in both neoaortic and pulmonic roots. Thereby, we describe our technique and the novel considerations for prosthetic choice with reconstruction of both the neoaortic root and pulmonary artery, with satisfactory postoperative results.

La détransposition artérielle constitue le traitement de référence dans les cas de dextro-transposition des gros vaisseaux. De nouvelles données, issues du suivi à long terme, nous permettent de mieux comprendre l'évolution naturelle à la suite de cette intervention et les complications tardives qui y sont associées, y compris les diverses interventions à réaliser pour les corriger. Étant donné les caractéristiques anatomiques uniques de ces patients et l'augmentation de leur espérance de vie, il est nécessaire de proposer des options efficaces de réparations chirurgicales pour remédier aux changements anévrismaux et dégénératifs des racines néoaortique et pulmonaire. Ainsi, nous décrivons la technique que nous avons utilisée et les nouveaux éléments qui entrent en ligne de compte dans le choix d'une prothèse pour une reconstruction de la racine néoaortique et de l'artère pulmonaire, avec des résultats postopératoires jugés satisfaisants.

Application of Rikkli and Regazzoni three-column theory in distal radius intraarticular fractures and its functional and radiological assessment.

Objectives: To determent the effectiveness of Rikli and Regazzoni three-column theory in treating intra-articular fractures of the distal radius with T-plate and K-wire in terms of functional outcome and fracture union. METHODS: The cross-sectional study was conducted at the Department of Orthopaedic Surgery and Traumatology, King Edward University, Mayo Hospital, Lahore, Pakistan, from June 2013 to March 2017, and comprised patients aged 15-60 years having closed intraarticular fracture of the distal radius <1 month older. The subjects were divided into two group A, managed by percutaneous K-wire fixation, and group B, managed with open reduction and internal fixation using T-plates. Wound infection, supination and pronation, flexion and extension at the wrist joint, bone union and functionality were observed. All patients were followed up with intervals for 12 months in the out-patient department, and wound infection and supination and pronation of the forearm were observed clinically. Union was observed using the standard criterion, and function was evaluated using the Disabilities of Arm, Shoulder and Hand score. Data was analysed using SPSS 20. RESULTS: Of the 60 patients, there were 30(50%) with mean age 48.83±11.11 years in group A, and 30(50%) with mean age 49.87±13.45 years in group B. Overall, there were 49(81.7%) males and 11(18.3%) females. There were 33(55%) cases with right side involvement, and 27(45%) had the left side involved. Functionality imprived significantly in both groups (p<0.05). Union was observed in all cases in both groups, while the mean duration in group A was 9.21±1.74 weeks, and in group B it was 9.87±2.14 weeks. Conclusion: Restoration of the three columns of distal radius could either be fixed with T-plates and K-wires because there was no significant difference between the two groups.

A case report: symptomatic pericarditis post-COVID-19 vaccination.

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has led to the rapid development of COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) has recently reported increase in myopericarditis incidence post-COVID-19 vaccination. Post-vaccination myopericarditis as side effect has been reported, however, is infrequent. We described a case of pericarditis post-first dose of Pfizer-BioNTech vaccine. CASE SUMMARY: A patient presented with typical symptoms of pericarditis and related electrocardiogram and echocardiogram changes, 7 days post receiving the first dose of COVID-19 vaccine. No other causes were identified from series of investigations. Patient had good symptomatic relief with non-steroidal anti-inflammatory medication. DISCUSSION: The incidence of pericarditis post-vaccination is rare, with limited reporting in previous literatures. No causal relationship has yet to be established due to small number of cases. The benefits of COVID-19 vaccination currently outweigh the side effect profile and are recommended as the first-line approach to control the current pandemic.

Evaluation of osteogenic potential of Cissus quadrangularis on mandibular alveolar ridge distraction.

BACKGROUND: This randomized clinical trial was designed to evaluate osteogenic potential of Cissus quadrangularis in alveolar distraction to facilitate implant installation. MATERIAL AND METHODS: Twenty patients with atrophic ridge were treated by alveolar distraction. After completing distractor activation, patients were randomly divided into two equal groups according to administered drug (placebo and Cissus quadrangularis group). After a consolidation period, distractors were removed and implants were inserted. Clinical evaluation was done to assess wound healing, and distractor and implant stability. Histological evaluation was performed at time of implant insertion. Radiographic evaluation was performed to assess bone volume and density after distraction, as well as, density and bone loss around implant. RESULTS: Radiographic and histological results showed that bone formation and maturation of study group were faster than that of control group. There was a significant increased bone density in distracted area and around implant in study group than control group. A significant bone loss at end of consolidation period, and around implant at end of the study was reported in control group than study group. CONCLUSION: Cissus quadrangularis administration during the consolidation period is associated with increased osteogenic potential of distracted bone. The histological and radiographic findings of current study proved that Cissus quadrangularis not only enhances rate of new bone formation, but also bone density to withstand the biomechanical requirements of implant placement in a shorter time. Trial registration This study was retrospectively registered on www.ClinicalTrial.gov : NCT04669795-17\12\2020.

Pulmonary Artery Intimal Sarcoma: A Deadly Diagnosis in Disguise.

Pulmonary artery intimal sarcoma (PAIS) is a very rare tumour. The prevalence of PAIS is estimated to be between 0.001% and 0.003%, but this may be an underestimation because of potential misdiagnosis due to its similar presentation to that of pulmonary thromboembolism. The prognosis is very poor, with median overall survival between 11 and 18 months. We report a case of a 36-year-old man who presented to our cardiac surgery clinic reporting nonspecific symptoms and was found to have PAIS requiring surgical resection and adjuvant chemotherapy. We outline the radiologic features, pathologic characteristics, surgical approach, and chemotherapy treatment utilized.

Le sarcome intimal de l'artère pulmonaire est une tumeur très rare. On estime que sa prévalence se situe entre 0,001 % et 0,003 %. Elle pourrait cependant être plus élevée, étant donné que sa présentation est comparable à celle des thromboembolies pulmonaires et que les erreurs diagnostiques sont possibles. Le pronostic du sarcome intimal de l'artère pulmonaire est très sombre, la survie globale médiane variant de 11 à 18 mois. Nous décrivons le cas d'un homme de 36 ans qui s'est présenté à notre clinique de chirurgie cardiaque en décrivant des symptômes non distinctifs et qui a reçu un diagnostic de sarcome intimal de l'artère pulmonaire nécessitant une résection chirurgicale ainsi qu'une chimiothérapie adjuvante. Nous soulignons les ca-ractéristiques radiologiques et pathologiques du patient, l'approche chirurgicale adoptée et la chimiothérapie sélectionnée.

A Case of Systolic Anterior Motion After Mitral Valve Repair Causing Hemolytic Anemia: Mechanism and Treatment.

Hemolytic anemia after mitral valve repair and ring annuloplasty is uncommon when compared with mitral valve replacement. In this report we present the case of a 67-year-old woman who had undergone mitral valve repair with a Duran band and developed hemolytic anemia. Most patients with severe hemolysis after mitral valve repair undergo reoperation. However, in the present case, the hemolysis was found to be secondary to systolic anterior motion of the mitral valve and left ventricular outflow tract obstruction and was treated without the need for reoperation.

Anterior Tooth Replacement with an Implant in a Grafted Alveolar Cleft Site: Case Report with a 10-Year Follow-up.

The aim of this report is to present a case with a 10-year follow-up of a single anterior tooth dental implant replacement with a xenogenous bone graft in a patient with a large bone defect associated with a cleft lip and palate. At 10 years postloading, the implant was healthy and well-integrated. Although the implant restoration appeared slightly intruded due to growth and development at that time, the patient was happy with the esthetic result and refused corrections of the uneven occlusal plane.

Cost of acute stroke care for patients with atrial fibrillation compared with those in sinus rhythm.

BACKGROUND: Atrial fibrillation (AF) is a major risk factor for stroke. Cost-effectiveness studies of anticoagulants for stroke prevention in AF rarely utilise AF-stroke-specific cost data in their analyses, as data are limited. Data that exist do not account for AF found on prolonged cardiac monitoring after stroke, further underestimating the clinical and economic burden of AF-stroke. OBJECTIVE: Our objective was to investigate differences in direct medical costs of acute stroke care among patients with and without AF. METHODS: Data were prospectively collected from 213 consecutive patients with confirmed stroke (196 ischaemic [IS], 17 intracranial haemorrhage [ICH]), admitted to a UK district general hospital between November 2011 and October 2012. Sociodemographic, clinical and cardiac monitoring characteristics were recorded, and resource use was calculated using a 'bottom-up' approach. Univariate and multivariate stepwise regressions were performed to identify predictors of direct cost. RESULTS: Among patients with IS, 73 had AF (37%). These patients were older, experienced greater stroke severity, lengths of hospitalisation, inpatient mortality and discharge to institutionalised care than those without AF. Mean acute care costs for the year 2012 were £6,978 (standard deviation [SD] 6,769, range 510-36,952). Mean (SD) costs were significantly higher for patients with AF than for those without (£9,083 [7,381] vs. £5,729 [6,071], p = <0.001). AF independently predicted acute care cost along with history of heart failure and stroke severity. The adjusted independent effect of having AF on costs was an additional £2,173 (95% confidence interval 91-4,254; p = 0.041). Costs for patients with an ICH did not differ according to cardiac rhythm. CONCLUSION: Direct medical costs of acute stroke care for patients with AF may be 50% greater than for patients without. Economic studies should take this into account to ensure the benefits of anticoagulants are not underestimated.