Controlling postoperative pain after third molar extraction with a dexamethasone and articaine injection: a double-blind randomized controlled trial.

OBJECTIVES: To evaluate the benefits of submucosal administration of a dexamethasone and articaine mixture on postoperative pain after mandibular third molar extraction. METHOD AND MATERIALS: This was a double-blind randomized controlled pilot trial of consecutive patients requiring surgical removal of mandibular third molars. Immediately post extraction, the surgeon administered a submucosal injection. The surgeon was masked to the content of the injection, which contained either a mixture of 10 mg dexamethasone and 68 mg articaine ("study group") or the same volume of saline only ("control group"). Pain severity was assessed by questionnaire (postoperative symptom severity [PoSSe] scale) 7 days after the procedure. RESULTS: Sixty subjects were enrolled. Patients in the study group had significantly lower PoSSe pain intensity scores than subjects in the control group (P = .004). The combined postoperative PoSSe pain score was significantly lower in the study group than in the control group (P = .016). There was no significant difference in pain duration between the two groups (P = .237). CONCLUSION: Submucosal injection of dexamethasone/articaine solution after surgical extraction of mandibular third molars is effective in reducing pain intensity.

Unique challenges in naval military dentistry.

Divers are regularly exposed to a unique and changing environment that dentists must consider when treating such patients. This review focuses around two case studies encountered in naval dentistry: (i) diving barotrauma (pressure-induced injury related to an air space); and (ii) scuba diving mouthpiece-related oral conditions. Each condition is described by its effect on the oral cavity and in particular the teeth. Then we generally review the latest literature on the different effects of scuba diving on the diver's head, face and oral regions and emphasize methods of dental disease prevention, diagnostic tools and treatment guidelines.

Plasmodium's bottomless pit: properties and functions of the malaria parasite's digestive vacuole.

During intraerythrocytic growth, the human malaria parasite Plasmodium falciparum degrades up to 80% of the host cell's hemoglobin inside an acidified organelle called the digestive vacuole (DV). Here, the globin chains are broken down by a number of proteases, while heme is detoxified through biomineralization, a process that is targeted by several potent antimalarial drugs. This review explores our current understanding of the DV, including the digestion of hemoglobin, the sequestration of heme, and the functions of lipids and transporters of the DV membrane. Furthermore, the mechanisms of drug action inside the DV and the molecular adaptations that mediate resistance are discussed.

Factors associated with prolonged hospitalizations from odontogenic infections in children.

OBJECTIVE: Oro-facial infections are common pathologies comprising a substantial health concern in the pediatric population. Incorrect or late treatment may lead to serious and possibly life-threatening complications. The aim of this study is to analyze variables associated with prolonged length of hospital stays (LOS) due to odontogenic infections in children. STUDY DESIGN: Data was collected from the records of patients (age <15 years) hospitalized due to odontogenic infections at Poriya Medical Center during the period of 1/2010-12/2015. Patients with oro-facial infections originating from other organs were excluded from the study as well as children with underlying systemic medical conditions that may affect recovery. RESULTS: A total of 411 patients (mean age 6.5 ± 2 years) were included in this study, with 58.4% being male. There were significantly higher (p < 0.05) values of white blood cell (WBC) counts in patients with >3 days LOS. Patients with >3 days LOS were also significantly older (8.4 vs. 6.3 years). There were no significant differences in sex distribution or other clinical or laboratory parameters between the groups. CONCLUSION: Older child age and higher WBC counts on admission are indicators for prolonged LOS.

Quality of Life After Class III Repair Orthognathic Surgery: Five-Year Retrospective Study.

OBJECTIVE: To evaluate the effect of orthognathic surgery on the long-term quality of life of patients with presurgical skeletal Class III and to identify its strongest effect-whether esthetic, social, or functional. MATERIALS AND METHODS: In this retrospective cohort study, the subjects were patients after orthognathic surgery for repairing skeletal Class III. Fifty-five patients who had undergone orthognathic surgery from 2013 to 2018 in the oral and maxillofacial surgery department participated in this study. Each participant completed a modified questionnaire used to assess the patient's esthetic, social, and functional abilities after orthognathic surgery. RESULTS: The rate of esthetic improvement in orthognathic surgery patients was 88%. More than four-fifths (81.8%) of the patients reported improvement in their personal and social self-esteem and confidence. Finally, 40.7% of the patients reported functional improvement. No significant differences between male and female patients were found. All but one of the patients recommended orthognathic surgery for patients with similar problems. One in six (17.3%) patients was dissatisfied with the nasal appearance after the surgical procedure, while almost a quarter (21.8%) reported worsening of their mouth opening, and 25.4% reported worsening of TMJ (Temporo-Mandibular Joint) symptoms. Analysis of the results revealed no statistically significant pattern connecting preoperative overjet or overbite measures with satisfaction rates. CONCLUSIONS: In this study, patient satisfaction with the orthognathic surgical procedure was mostly a result of improvements in facial esthetics, followed by psychological well-being and functional abilities. Most dissatisfaction after the orthognathic surgical procedure was related to nasal appearance, mouth opening, and TMJ complaints.

Coping and Health-Related Quality of Life after Closed Head Injury.

OBJECTIVES: In the present study the relationship between illness coping and health-related quality of life (HRQOL) in patients after closed head injury (CHI) was analyzed. Furthermore, the study was performed to assess the relative significance of clinical, neuroradiological, psychosocial variables and coping activities after CHI. We hypothesized that the effect of a depressive coping style is significantly stronger than that of all other variables considered. PATIENTS AND METHODS: This cross-sectional study took place at the outpatient clinic of the Department of Neurosurgery of the University of Technology (RWTH) Aachen, Germany. Of a total of 98 patients 1-2 years after CHI living in the catchment area of the university hospital fulfilling the inclusion criteria 63 individuals (mean age 40.6 years; 46 males) with a mean of 17.6 months after CHI took part in the study. HRQOL was assessed by means of the Aachen Life Quality Questionnaire (ALQI) and illness coping by the Freiburger Fragebogen zur Krankheitsverarbeitung (FKV). RESULTS: The patients complained most frequently of impairments in their HRQOL in the areas of free-time activities and social contact. The most intensely used coping activities were distraction and self-management, active problem-oriented coping and religion and looking for sense. Regression analyses revealed exclusively the depressive coping style as the most important predictor of subjectively impaired HRQOL explaining up to 44% of the variance. There was only a modest relationship between patient age and active problem-oriented coping (r = .43; p < .01). The degree of education was negatively associated (r= -.35; p < .01) with depressive coping. A moderate severity of the injury led to significantly more intense activities in the area of minimizing and wishful thinking as compared to a mild CHI (p < .05). CONCLUSIONS: In patients after CHI rehabilitation measures should focus to the HRQOL areas of free-time activities and social contact. Specific psychological interventions are called for in order to tackle the obviously dysfunctional depressive coping style.

Does fasting during Ramadan increase the risk of the development of sialadenitis?

BACKGROUND: Ramadan is a month within the Islamic lunar calendar when Muslims are required to fast (abstain from food and drink) during the daytime (from sunrise to sunset) for the entire month. Due to the established connection between fasting and dehydration and acute sialadenitis, the aim of this study is to determine if there is a higher frequency of sialadenitis among the Muslim population during Ramadan than during other months of the year. METHODS: We conducted a retrospective study using the medical records of 120 Muslim patients admitted to the emergency room (ER) and diagnosed with acute sialadenitis over a 5-year period at the Baruch Padeh Medical Center, Poriya, and St. Vincent de Paul (French) Hospital, Nazareth, both located in Israel. The study group were Muslim patients, with the aforementioned diagnosis, admitted during Ramadan, while the control group included patients diagnosed with sialadenitis during the rest of the year. We analyzed overall admission frequency as well as descriptive and diagnostic data, including age, sex, gland involved and several blood test results. RESULTS: During the month of Ramadan, the admission of Muslims with a diagnosis of acute sialadenitis was more than double that during the other months of the year - a difference that was found to be statistically significant (p = 0.001). Additionally, we found that Ramadan sialadenitis patients had significantly higher leukocyte numbers at admission (p = 0.0085) and, importantly, a significantly higher level of dehydration (blood urea nitrogen (BUN)/creatinine ratio) than non-Ramadan sialadenitis patients (p = 0.0001). CONCLUSION: There is evidence that fasting in Ramadan may increase the risk for the development of acute sialadenitis. Our results suggest that this may be the result of dehydration.

The Face of War: Maxillofacial Patients in the Syrian Civil War.

The type of the armed conflict on the Syrian battle field acquired several types of injuries; including injuries that were caused by explosive, shrapnel and blast injuries.In the current study, the authors conducted an overview of maxillofacial patients, who mainly suffered from ballistic injuries in term of injuries, reconstruction, and management.Overall, 53 maxillofacial Syrian patients were treated. The most prominent injury was soft tissue lacerations (21/97) and in terms of hard tissue injuries, the most prominent site was the mandible (N = 19) while the ramus and the body presented the most common sub-sites of injury. Hard tissue injuries were treated either by close or open reduction to obtain primary stabilization.From the psychological aspect, most of the patients suffered from guilt for leaving the combat area, those patients were mostly males in their 20s or 30s. On the other hand, older patients suffered mainly from depression, stress, and fear of returning to their home land.To conclude, the Syrian civil war has several characteristics that defer from other combats. Thus, the management of Syrian patients has to be tailored accordingly.

Trigeminal Neuropathy After Mandibular Fractures: Epidemiology and Neurophysiologic Diagnosis.

OBJECTIVES: To study the trigeminal nerve neuropathy prevalence after mandibular fractures and follow nerve recovery and to examine associations with clinical features. SUBJECTS: The files of 304 patients treated for 424 mandibular fractures in Hadassah Medical Center between 2001 and 2008 were analyzed. Twenty-five patients with paresthesia were examined by electro-diagnostic conduction test (quantitative sensory testing). RESULTS: The most common fracture sites were the symphysis (28.5%) and condyle (21.4%). A strong correlation between fracture severity and treatment modality was found. Nerve damage occurred in 13.4% of nondisplaced fractures and in 65.3% of >5 mm displaced fractures. Patients who were treated by open reduction internal fixation demonstrated the biggest difference in quantitative sensory testing values between the affected and nonaffected sides. C nerve fibers were the most damaged and least regenerated. There was correlation between damage perception and objective test results. CONCLUSIONS: There is a correlation between fracture type and displacement severity on neurologic deficit and prognosis. The objective neurosensory damage was manifested by higher nerve excitation threshold on the injured side. Patients should be informed on the prognosis of neurologic deficit according to fracture type.

Polymorphous Low-Grade Adenocarcinoma: A Proposed Reconstruction Protocol Based on Past Surgical Experience.

BACKGROUND: To propose a reconstructive protocol based on surgical management experience of polymorphous low-grade adenocarcinoma (PLGA) and the location of the primary lesion. METHODS: Data on the surgical management and the reconstructive technique of 14 histologically conformed patients with PLGA, all treated by the same surgeon, were analyzed and evaluated. RESULTS: Mean follow-up period in our series was 6.2 years. Mean age at diagnosis was 55.5 years and female to male ratio was 2.2:1. The most common presenting sign was a nonpainful lump or mass in an intraoral location. Most patients were managed by wide local excision and reconstruction method varied from primary closure to the use of radial forearm graft. Recurrence appeared in one of the patients in this series, while 2 required further radiation therapy. A protocol for reconstruction of intraoral patients with PLGA is suggested based on our analysis. CONCLUSION: Surgical management is the gold standard for PLGA treatment. Neck dissection is recommended only in patients with presurgery fine-needle aspiration confirmed lymph node involvement. The reconstruction depends mainly on location and size of the primary lesion.

Plasmodium Para-Aminobenzoate Synthesis and Salvage Resolve Avoidance of Folate Competition and Adaptation to Host Diet.

Folate metabolism is essential for DNA synthesis and a validated drug target in fast-growing cell populations, including tumors and malaria parasites. Genome data suggest that Plasmodium has retained its capacity to generate folates de novo. However, the metabolic plasticity of folate uptake and biosynthesis by the malaria parasite remains unresolved. Here, we demonstrate that Plasmodium uses an aminodeoxychorismate synthase and an aminodeoxychorismate lyase to promote the biogenesis of the central folate precursor para-aminobenzoate (pABA) in the cytoplasm. We show that the parasite depends on de novo folate synthesis only when dietary intake of pABA by the mammalian host is restricted and that only pABA, rather than fully formed folate, is taken up efficiently. This adaptation, which readily adjusts infection to highly variable pABA levels in the mammalian diet, is specific to blood stages and may have evolved to avoid folate competition between the parasite and its host.

An in silico down-scaling approach uncovers novel constituents of the Plasmodium-containing vacuole.

During blood stage development the malaria parasite resides in a membrane-bound compartment, termed the parasitophorous vacuole (PV). The reasons for this intravacuolar life style and the molecular functions of this parasite-specific compartment remain poorly defined, which is mainly due to our limited knowledge about the molecular make-up of this unique niche. We used an in silico down-scaling approach to select for Plasmodium-specific candidates that harbour signatures of PV residency. Live co-localisation of five endogenously tagged proteins confirmed expression in the PV of Plasmodium berghei blood and liver stages. ER retention was ruled out by addition of the respective carboxyterminal tetrapeptides to a secreted reporter protein. Although all five PV proteins are highly expressed, four proved to be dispensable for parasite development in the mammalian and mosquito host, as revealed by targeted gene deletion. In good agreement with their redundant roles, the knockout parasites displayed no detectable deficiencies in protein export, sequestration, or PV morphology. Together, our approach improved the catalogue of the Plasmodium PV proteome and provides experimental genetics evidence for functional redundancy of several PV proteins.

Immunogenicity and mechanisms of action of PnuBioVax, a multi-antigen serotype-independent prophylactic vaccine against infection with Streptococcus pneumoniae.

Streptococcus pneumoniae has multiple protein antigens on the surface in addition to the serotype specific polysaccharide capsule antigen. Whilst the capsule antigen is the target of the polysaccharide vaccines, bacterial proteins can also act as targets for the immune system. PnuBioVax (PBV) is being developed as a multi-antigen, serotype-independent prophylactic vaccine against S. pneumoniae disease. In this study we have sought to elucidate the immune response to PBV in immunised rabbits. Sera from PBV immunised rabbits contained high levels of IgG antibodies to the PBV vaccine, and pneumococcal antigens PspA, Ply, PsaA and PiuA which are components of PBV, when compared with control sera. The PBV sera supported killing of the vaccine strain TIGR4 in an opsonophagocytic killing assay and heterologous strains 6B, 19F and 15B. In addition, incubation in PBV sera led to agglutination of several strains of pneumococci, inhibition of Ply-mediated lysis of erythrocytes and reduced bacterial invasion of lung epithelial cells in vitro. These data suggest that PBV vaccination generates sera that has multiple mechanisms of action that may provide effective protection against pneumococcal infection and give broader strain coverage than the current polysaccharide based vaccines.

Extended Applications for Cochlear Implantation.

The indications for cochlear implantation (CI) have expanded over the last few years. There is evidence that some adult patients with pre- or perilingual onset of deafness may gain from implantation. Similarly, CI in patients with single-sided deafness may offer significant benefits in terms of quality of life and social as well as academic development. In this setting, directional hearing may be restored and speech comprehension, especially in noise, may be optimized. In patients with intractable tinnitus and profound hearing loss, CI not only improves speech perception, but also helps to reduce the tinnitus in the deaf ear.

An Unusual Prohibitin Regulates Malaria Parasite Mitochondrial Membrane Potential.

Proteins of the stomatin/prohibitin/flotillin/HfIK/C (SPFH) family are membrane-anchored and perform diverse cellular functions in different organelles. Here, we investigate the SPFH proteins of the murine malaria model parasite Plasmodium berghei, the conserved prohibitin 1, prohibitin 2, and stomatin-like protein and an unusual prohibitin-like protein (PHBL). The SPFH proteins localize to the parasite mitochondrion. While the conserved family members could not be deleted from the Plasmodium genome, PHBL was successfully ablated, resulting in impaired parasite fitness and attenuated virulence in the mammalian host. Strikingly, PHBL-deficient parasites fail to colonize the Anopheles vector because of complete arrest during ookinete development in vivo. We show that this arrest correlates with depolarization of the mitochondrial membrane potential (ΔΨmt). Our results underline the importance of SPFH proteins in the regulation of core mitochondrial functions and suggest that fine-tuning of ΔΨmt in malarial parasites is critical for colonization of the definitive host.

Pediatric maxillofacial trauma: Epidemiologic study between the years 2012 and 2015 in an Israeli medical center.

BACKGROUND/AIM: Trauma is the leading cause of morbidity and mortality in the pediatric population worldwide, and Israel is no different in this aspect. Of these injuries, craniofacial trauma is a significant cause of morbidity in the pediatric population. The high occurrence of pediatric trauma is possibly related to a lower perception for the hazards that surround them, combined with the restless and adventurous nature that is typical of children. The aim was to perform a retrospective, epidemiological study on facial trauma in children examined in the emergency room in order to analyze the different patterns in pediatric maxillofacial trauma, to emphasize this data and educate those involved in preventing and treating children's injuries. MATERIALS AND METHODS: The database of pediatric maxillofacial trauma patients younger than 18 years registered at the Department of Oral and Maxillofacial Surgery at the Baruch Padeh Medical Center, Poriya during a period of 4 years (2012-2015) was reviewed and examined. The data collected were analyzed for each year separately and then comparisons and cross sections were made. RESULTS: This study examined 3034 files of pediatric maxillofacial and head trauma patients aged under 18. The comparison of frequency of the injuries between seasons reveals more injuries occur in the summer and 69.3% of the injuries occurred in boys. Average age was 6.5 years, with the most prevalent group being 0-5 years. The most common type of injury was blunt head trauma followed by facial lacerations and dental injuries. Most (84.5%) of the injuries occurred outside the education system. The number of injuries at the Arab villages was higher than in the Jewish villages. CONCLUSION: There is a marked difference in the injured children population with an increase incidence in the Arab child population and children under the age of 6.

Safety and immunogenicity of a novel multiple antigen pneumococcal vaccine in adults: A Phase 1 randomised clinical trial.

BACKGROUND: Pneumococcal vaccines, combining multiple protein antigens, provide an alternative approach to currently marketed vaccines and may provide broader protection against pneumococcal disease. This trial evaluated the safety and immunogenicity of a novel vaccine candidate PnuBioVax in healthy young adults. METHODS: In a Phase 1 double-blind study, 36 subjects (18-40 years) were randomised to receive 3 doses of PnuBioVax, 28 days apart, at one of three dose levels (50, 200, 500 µg) or placebo. Safety assessments included rates of emergent adverse events (AEs), injection site and systemic reactions. Immunogenicity endpoints included antibody titre against PnuBioVax and selected pneumococcal antigens. RESULTS: In the placebo (n=9) and PnuBioVax (n=27) vaccinated subjects, there were 15 and 72, reported TEAEs, respectively. The majority of TEAEs were classified as common vaccine related AEs. There were no serious AEs. Common vaccine-related AEs occurred in 13 PnuBioVax (48%) and 2 placebo (22%) subjects and were all headaches (mild and moderate). Injection site reactions, mostly pain and tenderness (graded mild or moderate) were reported, in particular in the 200 µg and 500 µg PnuBioVax groups. There were no clinically significant changes in vital signs, ECG or blood chemistries. Subjects receiving the higher dose (200 and 500 µg) demonstrated a greater fold increase in IgG titre compared with the starting dose (50 µg) or the placebo group. The fold-increase was statistically significantly higher for 200 and 500µg PnuBioVax vs 50µg PnuBioVax and placebo at each timepoint post-immunisation. Most subjects receiving 200 and 500 µg PnuBioVax demonstrated a ≥2-fold increase in antibody against pneumolysin (Ply), Pneumococcal surface antigen (PsaA), PiaA (Pneumococcal iron acquisition), PspA (Pneumococcal surface protein A) and pilus proteins (RrgB and RrgA). CONCLUSIONS: All dose levels were considered safe and well tolerated. There was a statistically significant increase in anti-PnuBioVax IgG titres at the 200 and 500 µg dose levels compared to 50 µg and placebo. TRIAL REGISTRATION NUMBER: NCT02572635https://www.clinicaltrials.gov.

Short- and long-term neurobehavioral effects of lumbar puncture and shunting in patients with malabsorptive hydrocephalus after subarachnoid haemorrhage: An explorative case study.

BACKGROUND: The neuropsychological effects of lumbar puncture and shunting in terms of cognitive functioning and quality of life were analyzed prospectively in four patients with malabsorptive hydrocephalus who became symptomatic in the chronic state after aneurysmal subarachnoid haemorrhage (SAH). METHODS: A comprehensive battery of neuropsychological tests was applied to four patients before and shortly after lumbar puncture and six months later. In three of them a shunt has been inserted, one patient was treated by repeated lumbar punctures. In addition, the patients completed a quality of life and a depression questionnaire before lumbar puncture and after shunting. The data were analyzed using single-case methodology. RESULTS: Hydrocephalus was associated with pronounced cognitive deficits in terms of functions of attention, short- and long-term memory, concentration and motor fine-coordination but not with a general mental deterioration. Quality of life and affect were also substantially impaired. Neuropsychological tests of fronto-cortical cognitive capacity, motor fine coordination and reaction time proved to be sensitive for the short-term effects of lumbar puncture. Memory functions and the capacity of divided attention needed more time for regeneration and improved substantially after shunt implantation. CONCLUSIONS: We found a complex pattern of cognitive improvement after lumbar puncture and shunting. Furthermore, our results also show a typical cluster of cognitive deficits associated with malabsorptive hydrocephalus including motor dysfunction. These preliminary findings should be confirmed in larger patient samples.

Prevalence of Headache in Cochlear Implant Patients: A Cross-sectional Study.

INTRODUCTION: In Internet forums and other social media many reports regarding chronic headaches after cochlear implantation can be found. Although quite rare, there are also some reports in the literature. However, little is known regarding the true prevalence of headaches in persons who have undergone cochlear implant surgery. OBJECTIVES: The primary aim of this study was to investigate the 1-year prevalence of headache in patients having received a cochlear implantation ("cochlear implant group") in comparison with patients having undergone middle ear surgery ("surgery group") and persons with no history of head and neck surgery ("non-ear-nose-throat [ENT] group"). METHODS: Cross-sectional, monocentric study using a validated headache questionnaire. RESULTS: Three hundred persons were asked to participate. Two hundred thirty four valid questionnaires were returned. The participants' median age was 62 years, of whom 45% were women. The prevalence of headache was 31% (95%-confidence interval [CI]: [21; 42]) in the cochlear implant group and 46% (95%-CI: [35; 57]) in the surgery group with no significant difference between these two subgroups (p = 0.071). In the non-ENT group the prevalence of headache was significantly higher than in the other two subgroups (64%, 95%-CI: [52; 74]). DISCUSSION: The prevalence of headache is not higher in cochlear implant patients in comparison to middle ear surgery patients, other, non-ENT patients and the general German or European population. CONCLUSION: Cochlear implantation does not seem to be associated with an increased risk for developing headache.

Heat shock protein complex vaccines induce antibodies against Neisseria meningitidis via a MyD88-independent mechanism.

BACKGROUND: Neisseria meningitidis are common colonizers of the human nasopharynx. In some circumstances, N. meningitidis becomes an opportunistic pathogen that invades tissues and causes meningitis. While a vaccine against a number of serogroups has been in effective use for many years, a vaccine against N. meningitidis group B has not yet been universally adopted. Bacterial heat shock protein complex (HSPC) vaccines comprise bacterial HSPs, purified with their chaperoned protein cargo. HSPC vaccines use the intrinsic adjuvant activity of their HSP, thought to act via Toll-like receptors (TLR), to induce an immune response against their cargo antigens. This study evaluated HSPC vaccines from N. meningitidis and the closely related commensal N. lactamica. RESULTS: The protein composition of N. lactamica and N. meningitidis HSPCs were similar. Using human HEK293 cells we found that both HSPCs can induce an innate immune response via activation of TLR2. However, stimulation of TLR2 or TLR4 deficient murine splenocytes revealed that HSPCs can activate an innate immune response via multiple receptors. Vaccination of wildtype mice with the Neisseria HSPC induced a strong antibody response and a Th1-restricted T helper response. However, vaccination of mice deficient in the major TLR adaptor protein, MyD88, revealed that while the Th1 response to Neisseria HSPC requires MyD88, these vaccines unexpectedly induced an antigen-specific antibody response via a MyD88-independent mechanism. CONCLUSIONS: N. lactamica and N. meningitidis HSPC vaccines both have potential utility for immunising against neisserial meningitis without the requirement for an exogenous adjuvant. The mode of action of these vaccines is highly complex, with HSPCs inducing immune responses via both MyD88-dependent and -independent mechanisms. In particular, these HSPC vaccines induced an antibody response without detectable T cell help.