Comparison of laboratory biomarkers for the prediction of in-hospital mortality and severity of acute pulmonary embolism: A multi-center study.

OBJECTIVES: To assess the specificity and sensitivity of prognostic biomarkers in individuals diagnosed with acute pulmonary embolism (PE). METHODS: This study retrospectively enrolled 162 patients from the 741 patients who were hospitalized with acute PE and diagnosed using pulmonary computed tomography (CT) angiogram at 5 hospitals in Saudi Arabia between January 2015 and December 2019. Pulmonary embolism patients classified into survivor and non-survivor groups. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width (RDW) were all recorded and were compared between the groups. The evaluation of mortality prediction, sensitivity, and specificity was carried out by employing receiver operating characteristic curves. RESULTS: The variables NLR and RDW exhibited a statistically significant correlation with increased mortality and disease severity. A total of 8 patients among the 162 patients died. At the cut-off value of 5.5, NLR was showed an association with all-cause mortality, demonstrating a sensitivity of 75% and a specificity of 82%. At the cut-off value of 18.15, RDW was found to be significantly associated with all-cause mortality, displaying a sensitivity of 63% and a specificity of 88%. CONCLUSION: Multiple parameters have been implicated in the mortality and severity of PE. Our study revealed a statistically significant association between NLR, RDW, and PE mortality. These tests are easily accessible and may provide insights into the mortality associated with PE.

A Primary Epithelioid Angiosarcoma Arising in a Bilharzial Urinary Bladder: A Reappraisal and Case Report.

BACKGROUND: Angiosarcoma (AS) of the urinary bladder is a very rare and aggressive malignancy with a dismal outcome. CASE REPORT: Here, we report a primary epithelioid angiosarcoma (EAS) of the urinary bladder in a forty-nine-year-old male patient who presented with severe hematuria. Cystoscopic examination revealed hemorrhagic ulcerated bladder mucosa but no definite mass lesions. Intractable hematuria raised the initial clinical impression of idiopathic hemorrhagic cystitis. Analysis of the cystoscopic biopsy revealed features of old bilharzial cystitis, markedly atypical epithelioid endothelial cells arranged as primitive anastomosing vascular structures and expressing vascular markers. The diagnosis of EAS was established. The patient developed intractable severe hematuria, and a radical cystoprostatectomy was performed. The patient was started on chemotherapy but suddenly developed widespread distant metastasis (liver, lung, suprarenal glands, and lymph nodes) and succumbed to death two months after the surgery. CONCLUSION: To the best of these authors' knowledge, we presented the first report of primary EAS arising in a bilharzial bladder. The relevant studies were discussed.

Effects of Implant Surface Debridement and Systemic Antibiotics on the Clinical and Microbiological Variables of Periimplantitis.

OBJECTIVE: To investigate the role of implant surface debridement alone and in conjunction with systemic antibiotics on the clinical and microbiological variables of periimplantitis. MATERIALS AND METHODS: Data of forty-six patients with at least one dental implant having bleeding-on-probing (BoP), probing pocket depth (PPD) of more than 5 mm, and radiographic bone loss of more than 3 mm were retrieved from clinical records. Data was recorded for dental implant with the deepest PPD, BoP, and bone loss from each patient. "Group-A" received implant surface debridement alone, while "group-B" additionally received systemic antibiotics. Clinical and microbiological data of patients were compared before and after the treatment. RESULTS: At the implant level, a significant reduction of PPD, mucosal recession (MR), and BoP was achieved for all patients. Group B achieved significant improvement in MR and BoP compared to group A at implant level. PPD, MR, and plaque scores showed improvement at implant site level. At 3 months recall visit, 44% of group A and 52% of group B implants required surgical treatment. The presence and proportions of studied bacteria of both groups did not differ significantly at the recall visit when compared to the initial visit. However, P. intermedia and P. micros showed a significant reduction in group A at the recall visit. CONCLUSIONS: Implant surface debridement improved the clinical parameters of periimplantitis. In addition, adjunctive use of systemic antibiotics increased mucosal recession and improved bleeding on probing in periimplantitis.

Characterization and Antimicrobial Susceptibility of Pathogens Associated with Periodontal Abscess.

Knowledge of microbial composition and antimicrobials' susceptibility to periodontal abscesses is vital for their successful treatment. The current study aims to provide a thorough overview of the clinical and microbial features of periodontal abscesses of the local community. The study was carried out at Rehman College of Dentistry, Peshawar, Pakistan between December 2019 to March 2020. Clinical measurements and microbial samples were collected from 45 subjects. Microbial samples were anaerobically cultured for the growth of selected bacterial species. E-test was used to assess the susceptibility of bacterial species grown from the patient samples to amoxicillin, azithromycin, metronidazole, and tetracycline. The majority of affected patients had preexisting chronic periodontitis. All abscesses clinically demonstrated bleeding on probing and suppuration. The periodontal abscess was most commonly associated with lower incisors and canines, followed by lower molars and then upper incisor and canine teeth. Fusobacterium spp. (73%) was the most frequently detected species followed by Prevotella intermedia/nigrescens (65%), Porphyromonas gingivalis (46%) and Aggregatibacter actinomycetemcomitans (24%). The detected clinical isolates of certain bacteria demonstrated resistance to all tested antibiotics except azithromycin. We conclude that Fusobacterium spp., P. intermedia/nigrescens, P. gingivalis, C. rectus, T. forsythia and A. actinomycetemcomitans are closely associated with periodontal abscess. Bacterial species associated with periodontal abscess demonstrated some level of antimicrobial resistance to amoxicillin, metronidazole and tetracycline while antibiotic resistance to azithromycin could not be demonstrated.

Observation on the closure of lambdoid suture in relation to age, sex and population variations using a novel radiographic technique - a prospective study.

OBJECTIVES: To study and compare the patterns of lambdoid suture closure bilaterally; to specify any relationship between progression of the union of lambdoid suture and age; to detect sexual and population variations in lambdoid suture closure. METHODOLOGY: A total of 98 subjects of both sexes, 20 years and beyond were included in the study. The state of fusion of the lambdoid suture was examined using a modified reverse panoramic radiograph (RPRg). Frederic's five-point rating scale was used to assess lambdoid suture closure status. Data obtained were subjected to statistical analysis. RESULTS: Cohen's Kappa measure of the agreement gave a figure of 0.96 for intra-examiner testing and 0.97 for inter-examiner testing. These values represent a good agreement. Grade 0 was observed in 16 (16.3%), grade 1 in 44 (44.9%), grade 2 in 09 (9.2%), grade 3 in 13 (13.3%) and grade 4 in 16 (16.3%) of the cases. The maximum numbers of cases were in age group 35-39 (24 (24.4%)) followed by age group 25-29 (19 (19.4%)). In the present study, there were 64 (65.3%) males and 34 (34.7%) females. When the comparison between males and female subjects was made, the closure was earlier in females. Most of the participants belonged to Arabian population (38 (38.7%)) followed by South Asian (33 (33.7%)) and least were from South East Asian population (27 (27.6%)). There were significant differences in suture closure in relation to age but insignificant with respect to sex and population. CONCLUSIONS: Assessment regarding the age of an individual is possible but the sex and population of an individual cannot be determined.

Parent's Knowledge, Attitude and Practice on Prevention of Early Childhood Caries in Al jouf Province, Saudi Arabia

Objective: To measure the knowledge, attitude, and preventive practices of parents in regards to their understanding of early childhood caries (ECC) in Al jouf province, Saudi Arabia (KSA). Material and Methods: A cross-sectional oral health survey was conducted among 228 parents, who were selected by stratified cluster sampling. A questionnaire consisting of 10 questions in each domain addressing knowledge, attitude, and preventive practice for ECC was applied. Scoring in the knowledge field included Yes/No/Don't know, while the attitude and practice domains used a 5-point Likert scale. Results: The mean values for knowledge of the respondents was 'Yes' (106.1 ±46.12), 'No' (63.5 ±50.95), and 'Don't know' (58.4 ±23.21); the p-value was p>0.05. The mean values for attitudes of the parents were strongly disagree (49.8 ±33.51), disagree (28 ±15.63), cannot say (47.4 ±20.33), agree (69.4 ±26.57), and strongly agree (33.4 ±30.48); the p-value was p<0.05. The mean values for preventive practices were strongly disagree (23.3 ±25.15), disagree (27.6 ±28.29), cannot say (38.9 ±31.8), agree (84.9 ±28.07), and stronglyagree (53.3 ±38.73); the p-value was <0.05. Conclusion: The parents did not have adequate knowledge of ECC but did have a good attitude and practice towards its prevention.

Primary neuroendocrine tumor of the testis.

Testicular neuroendocrine tumor is rare. It accounts for less than 1% of all testicular neoplasms. More than 60 cases have been published in the literature. A 27-year-old man presented with left testicular mass and underwent radical orchidectomy. Histological examination showed neuroendocrine tumor, confirmed by immunohistochemistry and electron microscopy. The patient showed no evidence of metastasis over 1-year follow-up post-orchidectomy in spite of extensive tumor necrosis.