A rare case of mandibular third molar displaced into submandibular space: A complication of mandibular third molar extraction.

Key Clinical Message: Accidental displacement of mandibular third molars or their roots into neighboring anatomical spaces, notably the submandibular region, during extraction, is a rare but significant complication. Comprehensive preoperative assessment, meticulous surgical techniques, and precise radiographic imaging play pivotal roles in successful management. Adhering to established protocols is imperative to mitigate potential complications and ensure optimal outcomes. Abstract: In this report, we emphasize the critical importance of comprehensive preoperative preparation to tailor surgical approaches and techniques in accordance with recognized surgical principles. Oral and maxillofacial surgery often involves the extraction of impacted lower third molars, a common surgical procedure. However, this procedure can present potential complications such as hemorrhage, tissue damage, infection, alveolar osteitis, paresthesia, and mandible dislocation. Unintentional displacement of a mandibular third molar or its root fragments into adjacent anatomical areas, such as the maxillary sinus or submandibular space, is a rare intra-operative exodontia complication that is seldom documented. A 44-year-old male patient presented with complaints of pain, discomfort, and limited mouth opening. He had previously attempted to have a tooth extracted, but the procedure resulted in a misplaced tooth. A painful, indurated swelling was observed at the patient's left mandibular angle. Radiographic analyses revealed a radiopaque lesion resembling the third molar tooth root. Utilizing orthopantomography and CT images, the misplaced root in the left submandibular region was accurately located. The tooth was successfully extracted following the elevation of a lingual flap. The patient was prescribed antibiotics and painkillers for 7 days, and he reported an uneventful recovery with no complications on the eighth postoperative day. Accidental displacement of lower third molars or root fragments into neighboring anatomical areas is a rare but potentially concerning complication. Common sites of displacement include the submandibular, sublingual, and pterygomandibular spaces. Risk factors for displacement encompass improper use of surgical instruments and variations in patient anatomical characteristics. The ease of extraction can be influenced by various factors, including the degree of impaction, root structure, and dental inclination. Recommended screening examinations include panoramic radiography, intraoral periapical (PA) radiography, and occlusal radiography. Precise diagnosis and localization necessitate radiographic assessments such as CT scans and panoramic radiography. Postoperative care involves administering analgesics, antibiotics, suturing, wound irrigation, and managing potential complications like swelling, discomfort, infection, and nerve damage. Accidental displacement of lower third molars or their roots into the submandibular region is an infrequent yet potential complication. Thorough case assessment and adherence to established protocols for appropriate access, judicious bone removal, and avoiding excessive force are imperative for clinicians in the field of oral and maxillofacial surgery.

Effect of Vitamin D Supplementation on the Hemoglobin Level in Chronic Kidney Disease Patients on Hemodialysis: A Systematic Review and Meta-Analysis.

The objective of this study was to evaluate the impact of vitamin D supplementation on hemoglobin levels (Hb) in patients with chronic kidney disease (CKD) undergoing hemodialysis. A systematic search was conducted in electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to April 21, 2023. Inclusion criteria were applied to select relevant studies. Statistical analyses were performed using Review Manager 5.4.1. A random-effects model was used to address heterogeneity, and the mean difference (MD) with the corresponding 95% confidence interval (CI) was reported. Ten studies were included in the analysis, comprising seven clinical trials, two randomized clinical trials, and one retrospective observational study. Subgroup analysis was conducted based on the duration of follow-up: 12 weeks, three months, six months, 12 months, 15 months, and 18 months. A significant increase in hemoglobin levels was observed after 12 months (MD = -0.98 [95% CI -1.88, -0.08]; p = 0.03; I2 = 91%) and 18 months (MD = -1.80 [95% CI -2.56, -1.04]; p < 0.00001; I2 = Not applicable). However, there was no statistically significant relationship between vitamin D supplementation and hemoglobin levels at 12 weeks, three months, six months, and 15 months. The pooled analysis demonstrated a significant increase in hemoglobin levels with vitamin D supplementation (MD = -0.61 [95% CI -0.96, -0.26]; p = 0.03; I2 = 60.7%). This analysis highlights the significant role of vitamin D supplementation in improving anemia in patients with CKD undergoing hemodialysis. Vitamin D supplementation was found to significantly increase hemoglobin levels, particularly after 12 months and 18 months of supplementation.

A Rare Symptomatic Case of Congenital Origin of Right Coronary Artery From Left Coronary Sinus.

An anomalous origin of the right coronary artery from the left coronary sinus is a rare congenital disorder, characterized by an asymptomatic presentation and an increased risk of myocardial infarction, arrhythmias, and sudden cardiac death. This disorder with an inter arterial course of the right coronary artery is subject to mechanical compression leading to various symptoms. Only a handful of studies are published related to the atypical origin of coronary arteries. Therefore, we present a case of a hospitalized adult diagnosed with an atypical origin of the right coronary artery from the left coronary sinus. A 51-year-old female presented with mid-sternal heaviness, pressure, and burning sensation, not accompanied by sweating, dizziness, or light-headedness. Biochemical studies revealed an elevated troponin 1 level of 0.12 ng/mL. A coronary arteriogram showed proximal stenosis of the right coronary artery. CT cardiac angiography revealed a large right coronary artery arising from the left cusp anterior to the left main coronary artery. The patient was treated with surgical revascularization therapy.

Functional and Nutraceutical Significance of Amla (Phyllanthus emblica L.): A Review.

Phyllanthus emblica L. (also popularly known as amla) is a tree native to the India and Southeast Asia regions that produces fruits rich in bioactive compounds that could be explored as part of the increasing interest in naturally occurring compounds with biological activity. Thus, this review aims to highlight the nutritional aspects, rich phytochemistry and health-promoting effects of amla. Scientific evidence indicates that polyphenols are central components in fruits and other sections of the amla tree, as well as vitamin C. The rich composition of polyphenol and vitamin C imparts an important antioxidant activity along with important in vivo effects that include improved antioxidant status and activity of the endogenous antioxidant defense system. Other potential health benefits are the anti-hyperlipidemia and antidiabetic activities as well as the anticancer, anti-inflammatory, digestive tract and neurological protective activities. The promising results provided by the studies about amla bioactive compounds support their potential role in assisting the promotion of health and prevention of diseases.

Comparative Analysis of Inhaled Insulin With Other Types in Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis.

To analyze the effect of Inhaled insulin in Type 1 Diabetes Mellitus and compare it with other routes of administration of Insulin. A systemic search was conducted from the following electronic databases: PubMed/Medline, Cochrane Library, and Google Scholar, from inception to 28th January 2022. All statistical analysis was conducted in Review Manager 5.4.1. All studies meeting inclusion criteria were selected. A random-effect model was used to pool the studies, and the result was reported in the Standard Mean Difference (SMD), Mean Difference (MD), and Risk Ratio (RR) with their corresponding 95% Confidence interval (CI). Thirteen randomized control trials were selected for our meta-analysis. Statistically significant results were obtained for comparing change in weight after insulin administration (MD= -1.08 [-1.21, -0.94]; p< 0.00001; I2= 74%). Other factors assessed were found to be non-significant like HbA1c (SMD= 0.03 [-0.80, 0.86]; p= 0.95; I2= 99%), fasting blood sugar (SMD= -0.31 [-1.52, 0.91]; p= 0.62; I2= 99%) and adverse effects (RR= 1.06 [0.97, 1.16]; p= 0.18; I2= 96%). In this systematic review and meta-analysis, we found that inhaled insulin is equally effective as subcutaneously administered insulin in patients with Type 1 Diabetes. The inhaled insulin was found to show less weight gain and fewer hypoglycemic shifts, with a similar effect on the blood glucose level. No significant difference was observed in the incidence of adverse events.

Uncovering the Industrial Potentials of Lemongrass Essential Oil as a Food Preservative: A Review.

The food industry is growing vastly, with an increasing number of food products and the demand of consumers to have safe and pathogen-free food with an extended shelf life for consumption. It is critical to have food safe from pathogenic bacteria, fungi, and unpleasant odors or tastes so that the food may not cause any health risks to consumers. Currently, the direction of food industry has been shifting from synthetically produced preservatives to natural preservatives to lower the unnecessary chemical burden on health. Many new technologies are working on natural prevention tools against food degradation. Lemongrass is one such natural preservative that possesses significant antimicrobial and antioxidant activity. The essential oil of lemongrass contains a series of terpenes that are responsible for these activities. These properties make lemongrass acceptable in the food industry and may fulfill consumer demands. This article provides detailed information about the role of lemongrass and its essential oil in food preservation. The outcomes of the research on lemongrass offer room for its new technological applications in food preservation.

The Influence of COVID-19 Pandemic on Physical Health-Psychological Health, Physical Activity, and Overall Well-Being: The Mediating Role of Emotional Regulation.

Background: Highly infectious respiratory disease COVID-19 emerged in Wuhan, China, and spread worldwide. Different measures have been adopted worldwide to contain the COVID-19, and these measures have various impacts on health-related quality of life (HRQoL). This study aimed to assess the impact of the COVID-19 pandemic (CP) and lockdown policy on physical health (PH)-psychological health (PsH), physical activity (PA), and overall well-being (OW) in the context of HRQoL, exploring the mediating role of emotional regulation (ER). Method: The current study was conducted in two provincial cities of China. An online survey was conducted in both the cities to collect the data. After quantifying the data, a total of 2,200 respondents data were analyzed through appropriate statistical techniques. Results: The study results indicate that CP was found significantly and negatively related to PH (ß = -0.157, t = 9.444, p < 0.001). A significant relationship was found between CP and PsH (ß = 0.779, t = 45.013, p < 0.001). The third prediction revealed a significant negative relationship between the CP and OW (ß = -0.080, t = 5.261, p < 0.001). The CP and PA had a significant negative relationship (ß = -0.047, t = 3.351, p < 0.001). Conclusion: The PH, PsH, and OW of the Chinese people were affected due to the CP and lockdown measures. It is suggested that ER intervention reduces the negative psychological impacts for improving quality of life. ER can function one's sentiments in their social environment effectively for quality of life.

Diagnostic Utility of Radiomics in Thyroid and Head and Neck Cancers.

Radiomics is an emerging field in radiology that utilizes advanced statistical data characterizing algorithms to evaluate medical imaging and objectively quantify characteristics of a given disease. Due to morphologic heterogeneity and genetic variation intrinsic to neoplasms, radiomics have the potential to provide a unique insight into the underlying tumor and tumor microenvironment. Radiomics has been gaining popularity due to potential applications in disease quantification, predictive modeling, treatment planning, and response assessment - paving way for the advancement of personalized medicine. However, producing a reliable radiomic model requires careful evaluation and construction to be translated into clinical practices that have varying software and/or medical equipment. We aim to review the diagnostic utility of radiomics in otorhinolaryngology, including both cancers of the head and neck as well as the thyroid.

Utility of Preoperative Blood-Oxygen-Level-Dependent Functional MR Imaging in Patients with a Central Nervous System Neoplasm.

Functional neuroimaging provides means to understand the relationship between brain structure and associated functions. Functional MR (fMR) imaging can offer a unique insight into preoperative planning for central nervous system (CNS) neoplasms by identifying areas of the brain effected or spared by the neoplasm. BOLD (blood-oxygen-level-dependent) fMR imaging can be reliably used to map eloquent cortex presurgically and is sufficiently accurate for neurosurgical planning. In patients with brain tumors undergoing neurosurgical intervention, fMR imaging can decrease postoperative morbidity. This article discusses the applications, significance, and interpretation of BOLD fMR imaging, and its applications in presurgical planning for CNS neoplasms.

Role of cardiac nuclear stress perfusion exam after computed tomographic coronary angiogram for evaluation of obstructive coronary artery disease in patients with chest pain.

BACKGROUND: Clinical workup for chest pain varies among institutions. Acute coronary syndrome (ACS) is the primary diagnosis to rule out in the differential diagnosis, due to its associated mortality and morbidity. Although studies have demonstrated efficacy of coronary computed tomographic angiography (CCTA) in diagnosis obstructive coronary artery disease (CAD), there is limited evidence in the clinical value of performing cardiac nuclear stress perfusion imaging [myocardial perfusion imaging (MPI)] exam in patients with chest pain after undergoing CCTA. We aim to evaluate clinical value of follow-up nuclear cardiac MPI in patients with chest pain who have undergone recent CCTA. METHODS: A total of 1,000 patients were evaluated in this IRB approved retrospective study who presented with symptoms of ACS. Patients who had elevated troponin or abnormal electrocardiogram (ECG) findings at initial presentation or prior to cardiac nuclear MPI were excluded from the study. All patients who underwent 64- or 320-detector row ECG-gated CCTA as well as a follow-up nuclear MPI. Patients who had diagnostics studies limited by artifact [e.g., suboptimal intravenous (IV) contrast bolus in CCTA, motion artifact on CCTA or MPI, etc.] were excluded. RESULTS: One hundred patients met the inclusion criteria. Patient demographics include average age 64.3 [32-89] years, 59 male, 41 females. Ninety-five/100 patients had at least one vessel with 50-70% coronary artery diameter stenosis measured on CCTA. There were no focal perfusion abnormalities identified on cardiac nuclear MPI in patients with less than 70% stenosis diagnosed on CCTA. Five percent of patients were identified with coronary arterial narrowing greater than 70% on CCTA and all 5 of these patients have evidence of abnormal cardiac nuclear stress test (perfusion abnormalities, chest pain, abnormal ECG). CONCLUSIONS: In low-to-intermediate risk patients with chest pain and evidence of non-critical coronary artery stenosis (i.e., less than 70% stenosis) diagnosed on CCTA, a follow-up cardiac nuclear perfusion imaging is of limited value.

Thoracic imaging finding of rheumatic diseases.

In the era of Precision Medicine, diagnostic imaging plays a key role in initial diagnosis and treatment response assessment in thoracic manifestation of various rheumatic disorders; resulting in increased dependency on imaging for treatment planning. Chest radiographs serve as a good initial screening tool for assessment of emergent and urgent thoracic conditions, e.g., pneumothorax, pulmonary edema, consolidation and pleural effusions. Cross-sectional imaging techniques, e.g., computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) are most commonly utilized to evaluate more detailed pulmonary and mediastinal manifestations of rheumatic conditions. Magnetic resonance imaging (MRI) and ultrasound are most commonly used in cardiovascular, neural and musculoskeletal structures. This review article aims to highly key common thoracic imaging findings of rheumatic disorders, highlighting imaging test of choice for the particular disorder.

Molecular Biomarkers in Multiple Sclerosis and Its Related Disorders: A Critical Review.

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system (CNS) which can lead to severe disability. Several diseases can mimic the clinical manifestations of MS. This can often lead to a prolonged period that involves numerous tests and investigations before a definitive diagnosis is reached. As well as the possibility of misdiagnosis. Molecular biomarkers can play a unique role in this regard. Molecular biomarkers offer a unique view into the CNS disorders. They help us understand the pathophysiology of disease as well as guiding our diagnostic, therapeutic, and prognostic approaches in CNS disorders. This review highlights the most prominent molecular biomarkers found in the literature with respect to MS and its related disorders. Based on numerous recent clinical and experimental studies, we demonstrate that several molecular biomarkers could very well aid us in differentiating MS from its related disorders. The implications of this work will hopefully serve clinicians and researchers alike, who regularly deal with MS and its related disorders.

Radiogenomics and Its Role in Lymphoma.

PURPOSE OF REVIEW: Imaging features of lymphoma vary regionally. Awareness of site-specific key imaging characteristics of lymphoma can aid in rapid staging and assist in prompt treatment. FDG PET/CT and conventional MRI are readily available diagnostic modalities with excellent sensitivity and good specificity. Diagnostic specificity can be enhanced using emerging PET radiotracers, e.g., FLT and FET. RECENT FINDINGS: Emerging research has shown higher dimensional analysis (radiomics and radiogenomics) of imaging data can yield information of the underlying genetic aberrations in lymphoma, which can aid in assessing real-time evolution of tumor. CT, PET/CT, MRI, and ultrasound accentuate the intrinsic qualities of lymphoma (e.g., FDG PET/CT for increased metabolic activity, FLT PET/CT for increased proliferation index, and DWI for increased cellularity) and play an essential role in its diagnosis and examination. Advanced radiogenomic analyses use radiomic parameters to deduce genetic variations of lymphoma, providing noninvasive, repeatable, and real-time surveillance of its genetic progression.

Utility of Preoperative Blood-Oxygen-Level-Dependent Functional MR Imaging in Patients with a Central Nervous System Neoplasm.

Functional neuroimaging provides means to understand the relationship between brain structure and associated functions. Functional MR (fMR) imaging can offer a unique insight into preoperative planning for central nervous system (CNS) neoplasms by identifying areas of the brain effected or spared by the neoplasm. BOLD (blood-oxygen-level-dependent) fMR imaging can be reliably used to map eloquent cortex presurgically and is sufficiently accurate for neurosurgical planning. In patients with brain tumors undergoing neurosurgical intervention, fMR imaging can decrease postoperative morbidity. This article discusses the applications, significance, and interpretation of BOLD fMR imaging, and its applications in presurgical planning for CNS neoplasms.

Polyhydroxybutyrate (PHB) biodegradation using bacterial strains with demonstrated and predicted PHB depolymerase activity.

The biodegradation of polyhydroxybutyrate (PHB) has been broadly investigated, but studies typically focus on a single strain or enzyme and little attention has been paid to comparing the interaction of different PHB depolymerase (PhaZ)-producing strains with this biopolymer. In this work, we selected nine bacterial strains-five with demonstrated and four with predicted PhaZ activity-to compare their effectiveness at degrading PHB film provided as sole carbon source. Each of the strains with demonstrated activity were able to use the PHB film (maximum mass losses ranging from 12% after 2 days for Paucimonas lemoignei to 90% after 4 days for Cupriavidus sp.), and to a lower extent Marinobacter algicola DG893 (with a predicted PhaZ) achieved PHB film mass loss of 11% after 2 weeks of exposure. Among the strains with proven PhaZ activity, Ralstonia sp. showed the highest specific activity since less biomass was required to degrade the polymer in comparison to the other strains. In the case of Ralstonia sp., PHB continued to be degraded at pH values as low as pH 3.3-3.7. In addition, analysis of the extracellular fractions of the strains with demonstrated activity showed that Comamonas testosteroni, Cupriavidus sp., and Ralstonia sp. readily degraded both PHB film and PHB particles in agar suspensions. This study highlights that whole cell cultures and enzymatic (extracellular) fractions display different levels of activity, an important factor in the development of PHB-based applications and in understanding the fate of PHB and other PHAs released in the environment. Furthermore, predictions of PhaZ functionality from genome sequencing analyses remain to be validated by experimental results; PHB-degrading ability could not be proven for three of four investigated species predicted by the polyhydroxyalkanoates (PHA) depolymerase engineering database.

Case 238: Spontaneous Pneumothorax Secondary to Intrapulmonary Necrobiotic Rheumatoid Nodule.

History A 54-year-old white woman with a history of rheumatoid arthritis who was taking glucocorticoids and methotrexate presented to the emergency department in December with worsening shortness of breath and chest heaviness for 1 week. She reported additional symptoms of weakness, headache, and arthralgia primarily involving her bilateral hands, wrist, ankles, and feet. She denied experiencing fevers, syncope or presyncope, focal neurologic deficits, chest pain, nausea, vomiting, unintentional weight loss, or recent trauma. Additional medical history included hypertension, asthma, degenerative disk disease, and migraine, all of which were reportedly controlled with medications. This patient had a smoking history of 80 pack-years, but she had quit smoking 2 months prior to presentation. She denied abuse of alcohol or recreational drugs and reported she was up-to-date on her immunizations, including those for pneumonia and flu. Family history was pertinent for breast cancer in her mother, sister, and maternal aunt. The patient reported normal findings at screening mammography and colonoscopy. A physical examination was remarkable for slightly asymmetric breath sounds, which appeared to be diminished on the right side. This patient had multiple joint deformities, most notably in the bilateral metacarpophalangeal joints. Initial electrocardiography findings and cardiac biomarkers were negative. Her complete blood count and basic metabolic profile were unremarkable. Posteroanterior and lateral chest radiographs were obtained in the emergency department. Subsequently, computed tomography (CT) of the chest was performed.