Magnitude of Viral Load Suppression and Associated Factors among HIV-positive Patients Receiving Antiretroviral Therapy.

BACKGROUND: Viral load assessment is the preferred method for diagnosing and confirming virologic failure for patients on antiretroviral therapy. This study aimed to assess the proportion of viral load suppression and identify associated factors among HIV-positive patients receiving antiretroviral therapy at the Pokhara academy of health science in Nepal. METHODS: This institution-based retrospective cohort study was conducted at Pokhara academy of health science in Pokhara, Nepal. The study included 567 HIV patients who were enrolled between January 2016 and December 2019 and had their viral load measured within a one-year period. Statistical analysis was performed using STATA version 13.0. The proportions of viral load suppression and non-suppression were determined. Bivariate and multivariate logistic regressions were performed to identify factors associated with viral load suppression. Statistical significance was determined at a 95% confidence interval and p < 0.05 Results: Out of the 567 HIV patients, 95.76 % (95% CI: 94.10-97.42) achieved viral suppression. In multivariate analysis, longer duration of antiretroviral therapy treatment (> 3 years) was independently associated with higher odds of achieving viral suppression compared to those on antiretroviral therapy for less than 6 months (adjusted odds ratio [aOR] = 11.98, 95% confidence interval: 1.32-108.81, p < 0.0027). Conversely, individuals in second-line treatment had significantly lower odds of viral suppression compared to those in first-line treatment (aOR = 0.19, 95% CI: 0.05-0.66, p < 0.009). CONCLUSIONS: Our study demonstrated a high rate of viral suppression among HIV patients receiving antiretroviral therapy, exceeding the UNAIDS 90-90-90 target. Longer duration of antiretroviral therapy and being in second-line treatment were identified as factors influencing viral load suppression. These findings emphasize the importance of early initiation and adherence to first-line treatment for optimal outcomes.

Molar-incisor malformation: A case report and clinical considerations.

Molar-incisor malformation (MIM) is a dental anomaly that has recently been presented in the literature. It features morphological root abnormalities affecting the permanent first molars, resulting in narrow, shortened or almost completely absent roots in patients who interestingly still present with clinically normal crowns. In some cases, this condition also involves the roots of the deciduous second molars in a similar manner and the maxillary central incisors may exhibit notching around the cervical region of the clinical crown. Root dysplasia of the permanent first molars compromises the long-term survival of these teeth and, in itself, presents a challenge when attempting to undertake any orthodontic treatment. This case report describes an incidental finding of a patient presenting with similar features to that of MIM, discusses the features and clinical implications of this newly discovered condition, and highlights the importance of undertaking a comprehensive radiological investigation before treatment.

Is visual imagery ability higher for orthodontic students than those in other disciplines? A cross-sectional questionnaire-based study.

OBJECTIVE: To investigate the effect visual imagery may have on career choice among current university students across a range of subjects and disciplines. SETTING: University College London (UCL), UK. DESIGN: Cross-sectional questionnaire-based study. PARTICIPANTS: The study compared four main groups of UCL students: current students at the Slade School of Fine Art; UCL Eastman Dental Institute; UCL Bartlett School of Architecture; and the Faculty of Laws. METHOD: A questionnaire based on the Vividness of Visual Imagery Questionnaire (VVIQ) was distributed along with questions regarding demographic information. RESULTS: There were no significant differences between the VVIQ scores across the four included Schools/Faculty: The Slade School of Fine Art; UCL Bartlett School of Architecture; Faculty of Laws; and UCL Eastman Dental Institute, F(3,219) = 2.160, P = 0.094. There were also no significant differences in the scores for the Eastman (M = 60.21, SD = 13.58) and the three other Schools/Faculty (M = 62.87, SD = 10.96); t(-1.317) = 221, P = 0.189, and no significant difference in the scores for the Orthodontic students (M = 60.80, SD = 13.39) and the remaining other included students (M = 61.44, SD = 9.68); t(-0.232) = 221, P = 0.817. Aphantasia was uncommon in this sample, with a prevalence of 0.9%. A positive correlation was found between age group and total VVIQ score, with older participants scoring higher on the VVIQ. Women were significantly more likely to say that their ability to visualise had affected their career choice than male respondents. CONCLUSIONS: There were no significant differences between the VVIQ scores across the four included Schools/Faculty. Visual imagery ability did not differ in dental or orthodontic students in comparison to other student groups. Further work is needed to replicate these findings in more diverse samples.

Bilateral root resorption of maxillary first permanent molars by unerupted second molars associated with orthodontic distalisation.

Root resorption is a common but undesirable side-effect of orthodontic treatment. It is a well-recognised phenomenon largely associated with impacted or unerupted teeth and in most cases, is mild and does not affect longevity of the affected teeth. This case report of a medically fit and healthy Caucasian boy who was undergoing orthodontic treatment at the Eastman Dental Hospital, UCLH (EDH) for management of his severe hypodontia, presents an unusual incident of bilateral resorption of his maxillary first permanent molars by the unerupted second molars. The near end-of treatment radiographs showed that both upper second molars were mesio-angularly impacted and resorbing the first molars; however, the patient reported no associated signs or symptoms. Bilateral Cone Beam Computed Tomography radiographs were requested for the posterior maxillary arch in the area of the molar dentitions and extensive root resorption affecting the first molars caused by the crown of the mesio-angularly impacted second molars was evident. This unusual bilateral root resorption of maxillary first molars associated with unerupted second molars is an uncommon presentation, with no similar case reports found in the literature. Great emphasis should be placed on informed valid consent and potentially making the patient aware of the small but potential risk of resorption of erupted terminal molars where orthodontic molar distalisation is considered.

Coronoid impingement syndrome: literature review and clinical management.

BACKGROUND: This case report discusses the unusual presentation of limited mouth opening as a result of bilateral coronoid process hyperplasia. CASE PRESENTATION: A 14.5-year-old male patient of white Caucasian ethnicity presented with limited mouth opening, mandibular asymmetry, and dental crowding. Investigations confirmed bilateral coronoid process hyperplasia and management involved bilateral intraoral coronoidectomy surgery under general anaesthesia, followed by muscular rehabilitation. Mouth opening was restored to average maximum opening within 4 months of surgery. CONCLUSION: Limited mouth opening is a common presentation to medical and dental professionals. The rare but feasible diagnosis of coronoid impingement syndrome should not be overlooked.

An index of orthognathic functional treatment need (IOFTN).

OBJECTIVE: To design a new index categorizing the functional need for orthognathic treatment. DESIGN: Laboratory-based study. SETTING: Records were obtained from two UK hospital-based orthodontic departments. PARTICIPANTS: A panel of four consultant orthodontists, experienced in providing orthognathic care, devised a new index of Orthognathic Functional Treatment Need (IOFTN) with the aid of the membership of the British Orthodontic Society Consultant Orthodontists Group (COG). Twenty-three consultants and post-CCST level specialists took part in the study as raters to test the validity and reliability of the new index. METHODS: A total of 163 start study models of patients who had previously undergone orthognathic treatment were assessed by the panel of four consultant orthodontists using the new index (IOFTN) and the agreed category was set as the 'gold standard'. Twenty-one consultants and post-CCST level specialists then scored the models on one occasion and two scored 50 sets of models twice to determine the test-re-test reliability. RESULTS: Kappa scores for inter-rater agreement with the expert panel for the major categories (1-5) demonstrated good to very good agreement (kappa: 0·64-0·89) for all raters. The percentage agreement ranged from 68·1 to 92% in all cases. Intra-rater agreement for the major categories was moderate to good (kappa: 0·53-0·80). CONCLUSIONS: A new index, the IOFTN, has been developed to help in the prioritization of severe malocclusions not amenable to orthodontic treatment alone. It demonstrates good content validity and good inter-rater and moderate to good intra-rater reliability. As a result of being an evolution of the IOTN, the familiar format should make it easy to determine functional treatment need within daily orthognathic practice.

Pyogenic granuloma: a rare side complication from an orthodontic appliance.

This case report discusses a rare side effect associated with the use ofa fixed quad helix orthodontic appliance. A 14-year-old healthy girl presented with a painful enlarging mass on her tongue, which was causing distress to both her and her parents. Investigations confirmed that the mass was a pyogenic granuloma and management involved surgical excision of the mass and removal of the quad helix appliance. At least once previous case associated with an orthodontic quad helix appliance has been reported in the literature.

A cephalometric study to investigate the skeletal relationships in patients with increasing severity of hypodontia.

OBJECTIVES: To determine the skeletal relationships in patients with hypodontia and analyze the effects of severity and pattern. MATERIALS AND METHODS: Pretreatment lateral cephalograms from 277 patients with hypodontia, categorized by the number of missing teeth as mild (1-2), moderate (3-5), or severe (> or =6), were digitized recording angular measurements and ratios and compared with published norms matched for age and gender. Pattern was determined as mandibular, maxillary, bimaxillary, bilateral, anterior, posterior, and anteroposterior. Linear regression models assessed relationships between number of missing teeth and cephalometric parameters, controlling for the pattern of hypodontia. RESULTS: For every additional missing tooth, SNA, SNB, and ANB decreased 0.3 degrees , 0.1 degrees , and 0.2 degrees , respectively; this was clinically significant for >4, >10, and >5 missing teeth, respectively. Mandibular to cranial base ratio decreased 0.3% for every additional missing tooth; this was clinically significant for >10 missing teeth. The MMPA decreased 0.3 degrees for every additional missing tooth; this was clinically significant for >7 missing teeth. Percentage LAFH decreased 0.2% for every additional missing tooth; this was significant for >7 missing teeth. Jarabak ratio increased 0.2% for each additional missing tooth; this was clinically significant for >10 missing teeth. Anterior hypodontia significantly decreased most cephalometric parameters. CONCLUSIONS: Patients with hypodontia demonstrated a tendency toward a Class III relationship, caused by decreased maxillary and mandibular angular prognathism and MnCB ratio, though the effect was greater on the maxilla than the mandible. Clinical significance was only associated with severe hypodontia. Vertically, there was a tendency toward decreased MMPA and %LAFH; this was clinically relevant only with severe hypodontia. Anterior hypodontia had a significant effect on skeletal relationship.