Risk assessment of human mpox infections: retrospective cohort study.

OBJECTIVES: The global supply of vaccines against mpox (previously called monkeypox virus infection) was significantly lower than the demand. Therefore, evidence-based vaccine prioritization criteria, based on risk assessment were needed. Our objective was therefore to identify the characteristics of individuals at the highest risk for mpox. METHODS: This population-based cohort study included all Clalit Health Services (CHS) subjects assumed to be at risk for mpox. The eligibility criteria for inclusion were determined based on known characteristics of people with infection worldwide and insights of lesbian, gay, bisexual, transgender, queer+ (LGBTQ+) -specialized CHS clinicians. Cox hazards models were used to identify the risk factors for mpox within the study cohort. The study commenced on 6 June 2022, the date of the first known mpox in CHS members, until 31 July 2022, when the mpox vaccination campaign started. RESULTS: A total of 8088 individuals of 4.7 million CHS members (0.18%) were identified according to the study inclusion criteria. Of those, 69 (0.85%) developed infection during the study period. Risk factors for mpox were birth in 1980 or later (hazard ratio, 5.04; 95% CI, 2.11-12.02), history of syphilis (2.62; 1.58-4.35), registration to primary healthcare clinics in the Tel Aviv district (2.82; 1.44-5.54), HIV-pre-exposure prophylaxis medication use (3.96; 2.14-7.31), PDE5 inhibitors use (2.92; 1.77-4.84), and recent sexually transmitted infections (STIs) within the last 18 months (2.27; 1.35-3.82). No infections were observed in individuals with none of the factors. Individuals with three or more risk factors had a 20.30-fold (10.39-39.69) higher risk for mpox compared with those with 0-2, with 85.5% (75.0-92.8%) sensitivity and 77.8% (76.9-78.7%) specificity. DISCUSSION: Weighting individuals' risk levels based on validated risk factors against vaccine availability can assist health systems in the equitable prioritization of vaccine allocation in various future outbreaks, given supply-demand gaps.

Real-world effectiveness of a single dose of mpox vaccine in males.

The recent global outbreak of the monkeypox (mpox) virus in humans was declared a public health emergency by the World Health Organization in July 2022. The smallpox and mpox vaccine (JYNNEOS; Modified Vaccinia Ankara-Bavarian Nordic; MVA-BN), provided as a two-dose regimen, is currently the primary vaccine utilized against mpox. However, the efficacy of MVA-BN against mpox has never been demonstrated in clinical trials to date. Due to the limited supply of vaccines, the World Health Organization has recommended prioritizing the vaccination of high-risk groups. We evaluated the real-world effectiveness of a single, subcutaneous dose of MVA-BN in this observational, retrospective cohort study, which included the analysis of electronic health records of all members of Clalit Health Services eligible for the vaccine on 31 July 2022. We used a Cox proportional hazards regression model with time-dependent covariates to estimate the association between vaccination and mpox while adjusting for sociodemographic and clinical risk factors. In an analysis of 2,054 male individuals who met vaccine eligibility criteria, 1,037 (50%) were vaccinated during the study recruitment period and completed at least 90 d of follow-up. During the study period, 5 and 16 infections were confirmed in vaccinated and unvaccinated individuals, respectively. The adjusted vaccine effectiveness was estimated at 86% (95% confidence interval, 59-95%). Our results suggest that a single dose of subcutaneous MVA-BN in this high-risk cohort is associated with a significantly lower risk of MPXV infection.

Deproteinized bovine bone in association with guided tissue regeneration or enamel matrix derivatives procedures in aggressive periodontitis patients: a 1-year retrospective study.

OBJECTIVES: To retrospectively evaluate and compare two regenerative periodontal procedures in young individuals with aggressive periodontitis (AgP). METHODS: Thirty-two patients aged 14-25 years (mean ± SD 19.3 ± 5.7) were diagnosed as having AgP with multiple intra-bony defects (IBDs) and treated by one of two regenerative modalities of periodontal therapy: guided tissue regeneration (GTR) using deproteinized bone xenograft (DBX) particles and a resorbable membrane (the GTR group), or an application of enamel matrix derivatives (EMD) combined with DBX (the EMD/DBX group). Periodic monitoring of treated sites included recording of probing depth (PD), clinical attachment level (CAL) and gingival recession. Pre-treatment and 1-year post-operative findings were statistically analysed within and between groups. RESULTS: The PD and CAL values decreased significantly with time, but not those between study groups. The mean pre-treatment and 1-year post-treatment PDs of the IBDs of the GTR group (n = 16; sites = 67) were 8.93 ± 1.14 mm and 3.58 ± 0.50 mm, respectively, and the mean CALs were 9.03 ± 1.03 mm and 4.16 ± 0.53 mm respectively. The mean PDs of the EMD/DBX group (n = 16; sites = 73) were 8.77 ± 1.04 mm and 3.61 ± 0.36 mm, respectively, and the mean CALS were 8.79 ± 1.04 mm and 3.77 ± 0.22 mm respectively (p < 0.001 for all). CONCLUSION: Surgical treatment of AgP patients by either GTR or by application of EMD/DBX yielded similarly successful clinical results at 1-year post-treatment.

Antral computerized tomography pre-operative evaluation: relationship between mucosal thickening and maxillary sinus function.

OBJECTIVES: to assess the correlation between maxillary sinus inferior mucosal thickening and sinus outflow obstruction. MATERIAL AND METHODS: the study included 280 computerized tomography (CT) scans (560 maxillary sinuses). CT aimed to assess sinusitis; trauma to the face and intubated patients were excluded. Mucosal thickening was graded as < 5 mm (1), < 10 mm (2), < 15 mm (3), < 20 mm (4) and > 20 mm (5), and classified by appearance as normal, rounded, circumferential, irregular, or complete. Maxillary sinus outflow was classified as patent or obstructed. RESULTS: mucosal thickening was found in 36.1% of the maxillary sinuses, graded as 31.2% (1), 34.2% (2), 12.9% (3), 5.4% (4) and 16.3% (5), and classified as rounded (11.8%), irregular (10.4%), circumferential (8.8%) and complete (5.2%). Sinus outflow was obstructed in 15% of the scans. Mucosal thickening of < 5 mm (11.1%), < 10 mm (36.2%) and > 10 mm (74.3%) was associated with sinus obstruction (P<0.0001). Rounded (6.1%), circumferential (55.2%), irregular (38.8%) and complete (100%) mucosal appearances were associated with sinus obstruction (P<0.001). When statistically combined, a substantial risk for sinus obstruction was observed with irregular mucosal appearance of > 5 mm (56.5% for grade 2 up to 82.6% for grades 3-5) and circumferential appearance (21.4% for grade 1 up to 100% for grades 3-5). A low risk for obstruction was found with the rounded appearance (mean 6.1%). CONCLUSIONS: irregular (> 5 mm), circumferential and complete mucosal appearance are associated with an increased risk for sinus outflow obstruction and an ENT consultation is recommended. A rounded mucosal appearance of any grade is associated with a low risk for sinus obstruction. Routine CT scans, including the maxillary sinus ostium, are recommended.

The efficacy of full-arch immediately restored implant-supported reconstructions in extraction and healed sites: a 36-month retrospective evaluation.

PURPOSE: Implants placed in fresh extraction sites and healed sites were restored simultaneously by cross-arch provisional fixed prostheses. Clinical and radiographic parameters were recorded for up to 36 months. MATERIALS AND METHODS: Treatment with a full-arch implant prosthesis, either screw-retained or cemented, was assigned to 54 patients. A total of 676 implants were placed in either immediate extraction sites (n = 367) or in healed alveoli (n = 309), followed by placement of a one-piece provisional prosthesis. The definitive restoration was placed 3 to 6 months after implant placement. Clinical parameters were recorded and digital radiographs obtained at 6, 18, and 36 months. The chi-square test, t test, and analysis of variance with repeated measures were used for statistical analysis of the outcomes. RESULTS: Osseointegration failed in 21 (3.1%) implants; 13 of these (62%) had been placed immediately after extraction. All occurred within 2 months of the surgical healing phase. Short (8-mm) and narrow (3.3-mm) implant configurations were significantly (P < .05) associated with failure. At 6, 18, and 36 months, average crestal bone resorption was 0.18 mm, 0.55 mm, and 0.79 mm for implants placed in fresh extraction sites and 0.31 mm, 0.78 mm, and 1.1 mm for implants placed in healed alveoli, respectively. These differences were statistically significant (P < .05 between sites at all examined periods). Crestal bone resorption also correlated to sites with simultaneous bone augmentation and implant placement. CONCLUSIONS: Implants placed and restored immediately in a cross-arch mode, whether in extraction sites or in healed alveoli, can be clinically successful and maintainable.

Histomorphometric assessment of bone formation in sinus augmentation utilizing a combination of autogenous and hydroxyapatite/biphasic tricalcium phosphate graft materials: at 6 and 9 months in humans.

OBJECTIVE: The aim of this study was to examine the efficacy of a new biphasic hydroxyapatite/tricalcium phosphate (HA/TCP) bone substitute in combination with particulate autogenous bone in sinus floor augmentation procedures. MATERIAL AND METHODS: A simultaneous or a two-stage sinus augmentation and implant placement were conducted in 28 patients. A mixture of HA/TCP and autogenous bone chips in a 1 : 1 ratio was used as the grafting biomaterial. Cylindrical specimen bone retrieval was performed in all patients except one. Specimens were harvested either at 6 (n=14) or 9 (n=13) months post-augmentation. For histologic and histomorphometric evaluations, the non-decalcified tissue processing (Donath's technique) was performed. RESULTS: Newly formed bone around the grafted particles was found in all samples. The encircling, highly cellular bone followed the outline of the grafted particles in direct contact. Both woven and lamellar types of bone were observed. Morphometrically, the total mean bone area fraction of all sections was 34.8+/-10.3%, increasing from 28.6+/-7.8% at 6 months to 41.6+/-8.3% at 9 months (P<0.001). Mean particle area fraction average was 25.5+/-11.6% and 23.5+/-9.3% at 6 and 9 months, respectively, with a total mean of 24.5+/-10.4%. The increase in bone area fraction was not significantly correlated to the decrease of the grafted particles area fraction. CONCLUSIONS: The biphasic HA/TCP showed biocompatible and osteoconductive properties. This alloplast as a composite with autogenous bone chips promotes newly formed bone, which increases in its fraction along an extended healing period.

A distinguishable observation between survival and success rate outcome of hydroxyapatite-coated implants in 5-10 years in function.

PURPOSE: To differentiate between the survival and success definitions of functional hydroxyapatite (HA)-coated implant prosthesis. METHODS: A total of 248 implants (62 patients), 5-10 years in function, were evaluated. The implant distribution length was 8 mm (6.5%), 10 mm (29.4%), 13 mm (30.2%) and 15 mm (33.9%). The diameter was 3.25 mm (60.1%) and 4 mm (39.9%). Probing depth (PD), gingival index (GI), height of keratinized mucosa (KM) and recession (REC) were measured. Periapical radiographs were taken to estimate the amount of crestal bone resorption (BL), mesially and distally, with the aid of a millimetric-scaled magnifying glass (x 8). Only implants that fulfilled the success rate criteria were considered as successful. All other functional implants were assigned to the non-successful group. All functional implant prostheses were defined as survival ones. RESULTS: The accumulative survival rate after 5 and 10 years was 94.4% and 92.8%, respectively. Accumulative success rates were 89.9% and 54%, respectively. Implants 13 and 15 mm in length (97.9% and 96.4%, respectively) had the highest survival rate, which was higher over implants 8 and 10 mm in length (75%, P<0.01 and 88.2%, respectively). The survival rate of 4 mm diameter implants compared with 3.25 mm was 96.5% and 90.3%, respectively (P=0.019). The average BL was 1.7, 0.92 and 2.79 mm for the survival, successful and non-successful defined implant groups. PD was 3.26, 2.79 and 4 mm and GI was 0.96, 0.75 and 1.57, respectively. These measurements were statistically different between implant groups. KM and REC measurements showed similar scoring for all groups. A correlation was shown between successful and non-successful implants on the score of GI and PD (P<0.001 in both). CONCLUSION: A distinguishable observation between survival and success rate was noted particularly in long-term observations. Implant length and diameter have an influence on the survival rate. Clinical parameter scores expressed an influence on the defined implant status.