A Mixed-methods Study Examining Inhaler Carry and Use among Children at School.

Objective: Asthma self-management depends partly on access to inhalers; for children, this includes independent inhaler carry and use at school ("self-carry"). Although laws and policies support self-carry, little is known about practices within schools. This study aimed to identify factors associated with inhaler self-carry among children and examine barriers and facilitators to self-carry.Methods: This mixed-methods observational study included child-parent dyads and nurses from four Chicago schools. Children and parents answered questions about asthma care and morbidity, confidence in self-carry skills, and facilitators and barriers to self-carry. Nurses reported asthma documentation on file and their confidence in children's self-carry skills. Analysis utilized logistic regression. Thematic analysis was performed for open-ended questions.Results: Of 65 children enrolled (mean = 10.66 years), 45 (69.2%) reported having quick-relief medication at school, primarily inhalers, and 35 (53.8%) reported self-carry. Inhaler self-carry was associated with controller medication use and parent confidence in child's self-carry skills. Children and parents identified several facilitators to self-carry: child's asthma knowledge, inhaler characteristics, and need for easy inhaler access. Barriers included child's limited understanding of asthma and inhalers, perception that inhaler is not needed, and limited inhaler access. Children also emphasized social relationships as facilitators and barriers, while parents described children's responsibility as a facilitator and inconsistent policy implementation as a barrier.Conclusions: Efforts to improve inhaler self-carry at school should focus on educating children about asthma and inhaler use, creating supportive environments for self-carry among peers and teachers, and fostering consistent implementation and communication about asthma policy among schools and families.

Maxillofacial trauma in a pregnant patient: Contemporary management principles with a case report & review of literature.

Trauma during pregnancy deserves special attention because of its management objectives, i.e. well-being of both pregnant woman and foetus. Maxillofacial trauma directly affects the nutrition of foetus by interfering with the normal functions in a pregnant woman such as mouth opening, mastication and breathing. Hence early restitution of form and function of maxillofacial skeleton is essential. However, the gravid status is associated with numerous anatomical and physiological changes which present with clinical dilemma related to imaging and treatment. A careful scrutiny of the patient's systemic and gestational status is absolutely essential before, during and after instituting any interventional procedures. We present a case of bilateral condyle fracture in a 30-year-old pregnant woman in the third trimester (32 weeks). She was treated with inter maxillary fixation using orthodontic brackets & elastics. After successful restitution of occlusion, the patient was advised aggressive physiotherapy which ensured normal mouth opening. Two weeks later, the patient delivered uneventfully. The patient was followed up at one month and 3 month and demonstrated restitution of normal occlusion, mouth opening and lower facial height. This article aims at analyzing the contemporary principles in management of maxillofacial trauma in a pregnant woman and clarifying the common misconceptions.

A comprehensive classification for impacted cuspids and bicuspids with a proposal for Difficulty Index Categorization: a single center evaluation of 4165 cases.

BACKGROUND: The aim of the current study was to propose a classification of impacted cuspids, and bicuspids based on their spatial position in the maxillary and mandibular arches and their radiological appearance. METHODS: This prospective study was conducted including all the patients who reported to our center for extractions, orthodontic treatment, missing permanent cuspids/bicuspids, removal of third molar teeth. All patients who reported within a time frame of 6 months were enrolled in the study. Orthopantomogram was advised for all the patients as a part of diagnostic work up. The panoramic radiographs and clinical data were reviewed and patients with evidence of impacted bicuspids and cuspids were included in the study and were advised to undergo a cone beam computed tomography to evaluate the 3-dimensional position of the impacted teeth. Treatment plan was decided based on the position of the impacted teeth and feasibility for orthodontic movement. Standard surgical protocol was followed for all the patients. The duration of the procedure from the time of incision till the suturing were tabulated and the difficulty of extraction was correlated with the current Difficulty Index to validate the same. RESULTS: A total number of 4165 patients were enrolled in the study and based on the inclusion and exclusion criteria, 3680 patients were excluded and 487 patients with impacted cuspids/bicuspids were included in the study. A total number of 231 patients had impacted maxillary cuspids and bicuspids and 256 cases had impacted mandibular cuspids/bicuspids. Amongst the 256 mandibular cuspid and bicuspid that were impacted, 62% were in position C while the rest of 38% were in position B. More than ⅓ of the teeth which were in position C had transmigrated (35%). Seventy-three percent of the maxillary teeth were in position C and 69% of these teeth were either transmigrated (29%), or were horizontally (38%) placed in the alveolus or inverted (2%). The rest of the 31% were found to be either mesially inclined or vertical. The average Difficulty Index for maxillary teeth was 8 and mandibular teeth was 9. Mandibular cuspids and bicuspids in position B and C took longer time for surgical removal compared to the maxillary teeth and this was statistically significant. CONCLUSIONS: The proposed clinical classification on impacted mandibular cuspids and bicuspids provides a structured approach to plan the treatment based on the 3-dimensional position of the teeth in the arch.

External auditory canal injuries in maxillofacial trauma - Proposal of a symptom-based treatment algorithm with a report of twelve cases.

Purpose: Injury to the external auditory canal (EAC) may occur following facial trauma. They manifest as otalgia, ear bleeding, otorrhea, facial palsy, or altered hearing. But literature regarding its management is sparse. The study aimed to identify the incidence and types of EAC injury in facial trauma, grade their severity, and propose a symptom-based treatment algorithm. Patients and Methods: This was a prospective case series involving patients with signs/symptoms of EAC injury following maxillofacial trauma. The EAC was evaluated by clinical examination, imaging, endoscopy, and audiometry. Clinical findings were graded into mild, moderate, and severe. Treatment was matched to clinical findings according to the proposed algorithm. The outcomes of the study were incidence and types of EAC injury in facial trauma and resolution of presenting signs/symptoms. Data were analyzed for descriptive statistics using SPSS software (v26; IBM, Armonk, NY). Results: A total of 88 patients reported with maxillofacial trauma during a 6-month period. Signs/symptoms of EAC injury were observed in 41 patients, of which 12 (11 males and 1 female) were confirmed with a diagnosis of EAC injuries. Eight patients demonstrated only cartilaginous injuries while three had bony injuries. Treatment was successful in 11 out of 12 patients, with a best point estimate of 0.86 (Z score-1.959, 95% CI). Conclusion: Clinical findings of EAC injury mandate thorough investigation to ascertain the site and severity of the injury. Symptom-based treatment of EAC injuries produces an effective resolution of signs/symptoms and improved treatment outcomes.

A Rare Case of Osteomyelitis Presenting as Cyst-Like Lesion in the Coronoid Process: A Diagnostic Challenge.

Cyst-like lesion in the coronoid process of the mandible is a challenging diagnosis to make, as it may present with a range of non-specific symptoms. A middle-aged woman reported a one-year history of non-bloody, pus discharge from the right angle of the mandible. There was a history of prior surgery comprising teeth removal two years ago for a painful swelling on the right side of her face, following which her symptoms regressed but in the due course, she developed a chronic sinus with draining abscess. Radiographic findings, in combination with clinical symptoms, are critical in the diagnosis and evaluation of cysts and cyst-like lesions of the jaws. The orthopantomograph (OPG) revealed a cyst-like lesion in the coronoid process of the mandible with an extra-oral sinus tract leading to the epicenter of the cyst-like radiolucency, and so this, in combination with the patient's atypical symptoms, presented a diagnostic challenge. This case report explores the events which led to the diagnosis of osteomyelitis and shows several unique learning points.

"Effects of flap modification on third molar extraction outcomes"-A randomised split mouth study.

AIM: The main purpose of this experimental study was to compare whether modifications in flap design influence the post-operative outcome of third molar surgeries. MATERIALS AND METHODS: This study was designed as a randomized, single-blinded,split-mouth cross-over comparative study. The predictor variables were the flap type; Conventional Ward's was used to expose the tooth with a difference in the anterior release incision between the groups.Oblique anterior releasing incision and vertical anterior releasing incisions were used for the control and study group respectively.The primary outcome variables were pain measured using VAS (Visual analogue scale), swelling in mm; mouth opening measured in mm, periodontal probing depth in a mm, wound healing by modified Landry's score and surgical accessibility. Statistical significance was set at 5% (α = 0.05). RESULT: Twenty five patients with bilateral, mirror-image impacted mandibular third molars participated in the study.The study group was associated with moderate swelling that was not statistically significant. .The outcome variables i.e. pain, wound healing, mouth opening, and periodontal pocket depth had no statistical difference on comparing the two groups. In terms of accessibility, the control group was found to be better with the statistical significance of p = 0.00184. CONCLUSION: Modifying conventional Ward's design influences the degree of swelling and surgical accessibility. Vertical anterior releasing incision in conventional Ward's has no advantage over conventional Ward's with oblique anterior releasing incision.

Inferior Repositioning of Coronoid Process for the Treatment of Temporomandibular Joint Subluxation/Dislocation.

Subluxation/dislocation of the temporomandibular joint (TMJ) is characterized by transient locking of the jaw following wide mouth opening. The etiology of the condition is multifactorial relating to hard-tissue or soft-tissue components of the joint. Myriad treatment procedures have been described in the literature, each with its own advantages and disadvantages. We present a new intraoral technique of coronoid repositioning for the treatment of TMJ subluxation/dislocation.

High Viremia and Wasting Before Antiretroviral Therapy Are Associated With Pneumonia in Early-Treated HIV-Infected Kenyan Infants.

BACKGROUND: Human immunodeficiency virus (HIV)-infected children are particularly susceptible to acute respiratory infections (ARIs). We determined incidence and cofactors for ARIs in HIV-infected infants receiving antiretroviral therapy (ART). METHODS: Human immunodeficiency virus-infected infants initiated ART at ≤12 months of age and were observed monthly for 2 years in Nairobi. Acute respiratory infection rates and cofactors were determined using Andersen-Gill models, allowing for multiple events per infant. RESULTS: Among 111 HIV-infected infants, median age at ART initiation was 4.5 months. Pre-ART median CD4% was 19%, and 29% had wasting. During 24-months follow-up while on ART, upper respiratory infection (URI) and pneumonia rates were 122.6 and 34.7 per 100 person-years (py), respectively. Infants with higher pre-ART viral load (VL) (plasma HIV ribonucleic acid [RNA] ≥7 log10 copies/mL) had 4.12-fold increased risk of pneumonia (95% confidence interval [CI], 2.17-7.80), and infants with wasting (weight-for-height z-score < -2) had 2.87-fold increased risk (95% CI, 1.56-5.28). Infants with both high pre-ART VL and wasting had a higher pneumonia rate (166.8 per 100 py) than those with only 1 of these risk factors (44.4 per 100 py) or neither (17.0 per 100 py). Infants with exposure to wood fuel had significantly higher risk of URI (hazard ratio [HR] = 1.82; 95% CI, 1.44-2.28) and pneumonia (HR = 3.31; 95% CI, 1.76-6.21). CONCLUSIONS: In early ART-treated HIV-infected infants, higher HIV RNA and wasting before ART were independent risk factors for pneumonia. Wood fuel use was associated with URI and pneumonia. Additional data on air pollution and respiratory outcomes in HIV-infected children may help optimize interventions to improve their lung health.