Unveiling the Silent Mass: Central Ossifying Fibroma of the Maxilla in an Edentulous Patient - A Case Report and Review of the Literature

Introduction. Ossifying fibroma is a rare, benign fibro-osseous lesion that primarily affects the mandible, with uncommon maxillary involvement. Diagnosing central ossifying fibroma (COF) in edentulous patients presents challenges due to the absence of dental-related symptoms. Herein, we present a rare case of COF in the maxilla of an edentulous patient, highlighting the diagnostic challenges, radiographic features, and surgical management. Case Report. A 35-year-old female presented with a painless swelling in the right posterior maxilla, progressively enlarging over six months. Clinical examination revealed a bony-hard, non-tender lesion with well-defined margins. Radiographic evaluation showed a well-circumscribed, mixed-density lesion with a sclerotic border, suggesting COF. Histopathological analysis confirmed the diagnosis, revealing bony trabeculae within a cellular fibrous stroma. The lesion was surgically excised, and the patient recovered uneventfully. Conclusion. This case highlights the importance of considering COF in maxillary swellings of edentulous patients, where delayed diagnosis is common. Advanced imaging and histopathology are crucial for accurate identification, and complete surgical excision ensures optimal outcomes

Ranula as a Complication of Dental Implant Therapy: A Case Report and Systematic Review

Introduction. Ranulas are pseudocysts caused by saliva retention or extravasation from the sublingual or submandibular gland. Trauma is believed to be the most common cause of ranula formation, but it can also result from ductal obstruction or congenital malformation. Ranulas are relatively rare to encounter in clinical practice and infrequently associated with dental implant therapy. Methods. This study presents a case report of ranula formation in the right sublingual gland in association with dental implant therapy. In addition, a systematic review of case reports on this problem was conducted. The study aimed to identify the etiology of ranula development during/after implant therapy in patients undergoing implant-based dental rehabilitation. An advanced search was conducted on October 22, 2024, using the Web of Science, Scopus, and PubMed databases. The exported data demonstrated that reports on ranula formation were scarce. Four studies met the eligibility criteria; three were included in this analysis after quality assessments. Results. It was found that procedures leading to ranula formation were dental implant surgery in the mandible with perforation of the lingual plate and laceration of the sublingual or submandibular gland and placement of implant-retained overdentures causing duct obstructions. The treatment approaches included salivary gland excision (when the gland was traumatized) and duct marsupialization (when the ducts were obstructed). In the case report presented in this study, the etiology was attributed to soft tissue trauma caused by the implant drill during surgery. Different treatment modalities were used, including marsupialization, incision, and drainage. However, all led to a recurrence, and the gland was completely removed. Conclusions. Ranula formation has rarely been associated with dental implant therapy, with only a few reports in the literature. This case report suggests that ranulas may develop during implant placement, even if the lingual plate is not perforated. Such complications can be prevented through meticulous treatment planning and precise surgical techniques. The treatment of choice for ranulas remains sialadenectomy, especially in patients with a history of recurrence

Neurobehavioral Roles of Acrylamide in Rats Fed a Cafeteria Diet from Weaning to Adulthood: Possible Distinctive Effects

Introduction. Acrylamide, an endocrine-disrupting compound with neurotoxic properties, has been shown to affect various neurobehavioral parameters, including anxiety. This study aimed to examine the effects of varying acrylamide doses on neurobehavioral parameters in male Wistar rats fed an obesogenic cafeteria diet from weaning to adulthood. Methods. Healthy male Wistar rats (four weeks old, n=24) were divided into four groups: control diet (CON), cafeteria diet (CAF), CAF plus acrylamide at 50 μg/kg body weight (AA1) administered by oral gavage, and CAF plus acrylamide at 170 μg/kg body weight (AA2) administered by oral gavage. The treatments were continued for twelve weeks, with each group consisting of six rats (n=6). An open field test (OFT) was conducted to assess anxiety-like behavior and locomotor activity, and a novel object recognition test (NORT) was performed to assess short-term recognition memory. Results. The total distance traveled was higher in the CAF and AA1 groups compared to the CON group. The total number of immobile episodes was lower in the AA1 and AA2 groups than in the CAF and CON groups. The number of entries into the corner zones was higher in the CAF and AA1 groups compared to the CON group. The distance traveled in the corner zones was higher in the CAF and AA1 groups compared to the CON group. The principal component analysis (PCA) indicated that the number of the corner zones (PC1) and the distance traveled in the center zone (PC2) were the primary variables separating the groups. Blood plasma interleukin-6 (IL-6) levels showed a significant negative correlation with the distance traveled in the center zone and a significant positive correlation with time spent in the corner zones. Conclusions. The present study demonstrated that consumption of an obesogenic cafeteria diet alone and exposure to lower doses of acrylamide (50 μg/kg) in combination with the cafeteria diet induced anxiety-like behavior and impaired locomotor activity in male Wistar rats. Additionally, the findings suggest a link between inflammation and the onset of anxiety-like behaviors. However, further research is necessary to elucidate the underlying mechanisms

Diagnostic Value of Hematological Parameters in Patients with Brucellosis

Introduction. Brucellosis, a widespread zoonotic disease caused by the genus Brucella, presents with nonspecific clinical manifestations, making early diagnosis challenging. This study aimed to evaluate the usefulness of hematological parameters as potential biomarkers for the preliminary diagnosis of brucellosis. Methods. A retrospective case-control study was conducted on 100 patients diagnosed with brucellosis and 100 healthy controls. The complete blood count parameters (neutrophils, lymphocytes, monocytes, and platelets), derived indices, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and pan-immune inflammation value (PIV), and C-reactive protein (CRP) levels were compared among the participants. CRP levels were measured by the nephelometric method. Receiver operating characteristic (ROC) analysis was applied for parameters showing significant differences. In addition, the patient group was divided into subgroups based on antibody titers, and differences in these parameters between the subgroups were analyzed. Results. Median CRP levels were higher in the patient group compared to the control group, whereas median neutrophil and lymphocyte counts were significantly lower. No significant differences were found in other hematological parameters and indices. In ROC analysis, CRP showed a sensitivity of 77.8% and a specificity of 95.0% at a cut-off value of 3.33 mg/L. Although neutrophil and lymphocyte counts showed statistical significance, their sensitivity and specificity were comparatively low. CRP levels in the 1/160 antibody titer group were lower than those in the 1/640, 1/1280, and > 1/1280 antibody titer groups (p = 0.006, p = 0.015, p = 0.014, respectively). Conclusions. CRP remains a valuable marker for the diagnosis of brucellosis. In contrast, no significant differences were found in NLR, PLR, MLR, SII, and PIV between brucellosis and healthy controls. Further research is warranted to identify new biomarkers that are easily accessible, cost-effective, and provide valuable information for the diagnosis and follow-up of brucellosis

Trends in Online Learning for Adult Learners in Science and Medical Education

Over the last several years, especially since the onset of the COVID-19 pandemic, numerous innovations in medical education have emerged to improve the quality of educational resources. As many students continue to rely on asynchronous and virtual tools for learning, this trend has become particularly evident. This review aims to provide insight into the latest technological and ideological research surrounding adult internet-based education and explore some of the hype within the literature over the last ten years. A comprehensive literature screening was conducted on Google Scholar, PubMed, and EBSCO between February 27, 2024, and September 14, 2024. Careful selection of articles addressing the evidence behind the various topics and their impacts on adult learning outcomes, including retention, attention, and engagement, was performed. An attempt was made to select basic and leading articles on the current trends in adult learning, specifically those influencing current trends in both online learning and medical education. A total of 43 papers were included for the final formulation of this narrative review. This review is firmly grounded in the concepts of andragogy and the idea that the student is the main driver of their education. The review linked the major themes that it discovered to this theory and explained how the major concepts were well grounded within the theoretical framework. Some of the most intriguing and increasingly important aspects include educational videos provided by school or discovered within the “hidden curriculum” of explanatory content on YouTube or other video-hosting platforms, the influence of video playback speed, the integration of virtual and augmented realities in both classrooms and simulation laboratories, and the use of massive open online courses to disseminate classroom materials to a much wider audience

A Rare Clinical Association of Type I Hereditary Angioedema and Acquired Epidermolysis Bullosa: A Case Report

Introduction. Both hereditary angioedema (HAE) and acquired epidermolysis bullosa (AEB) are extremely rare disorders, and their coexistence in a single patient is unique. Awareness of this exceptional association can aid in timely diagnosis and guide safe, individualized treatment strategies. Case Report. We present a case of a 38-year-old female with co-occurring type I HAE, associated with a heterozygous SERPING1 variant c.425T>C (p.Leu142Ser) of uncertain significance previously reported in individuals with angioedema, and a rare autoimmune subepidermal blistering disorder mediated by autoantibodies against type VII collagen – AEB. Since adolescence, the patient had experienced recurrent limb edema and atypical dermatological manifestations, including macules, vesicles, and bullae, predominantly in areas exposed to mechanical stress and frequently resulting in scar formation. The disease course later progressed with an episode of acute laryngeal edema following a dental procedure. Laboratory evaluation confirmed a critically low level of C1-inhibitor and an almost complete depletion of C4 in plasma, indicating chronic activation of the classical complement pathway. Given the frequent exacerbations and severe clinical course, long-term prophylactic therapy with intravenous C1-INH (1,000 IU twice weekly) was initiated. This treatment regimen led to sustained clinical remission, resolution of angioedema episodes, notable improvement in dermatologic symptoms of AEB, and a substantial enhancement in overall quality of life. Conclusions. The coexistence of HAE and AEB is exceptionally rare, with no prior cases identified. Complement dysregulation may link these conditions, underscoring the importance of considering autoimmune blistering disorders in HAE patients with atypical skin manifestations. This case highlights a potential role for complement-targeted therapies, warranting further clinical investigation

Investigation of the Effects of Different Polishing Methods on Tooth Surfaces in Smokers: An In Vitro Study

Introduction. This in vitro study aimed to compare the enamel and root surfaces of teeth between smokers and non-smokers after scaling with hand instruments and to evaluate surface characteristics of smokers’ teeth after applying different polishing methods. Methods. This study analyzed periodontally affected teeth extracted from heavy smokers and non-smokers, dividing them into six groups: Group 1: scaling with hand instruments (HI); Group 2: HI followed by polishing with paste (Nupro prophy paste); Group 3: HI followed by polishing with pumice (Imipomza); Group 4: HI followed by air polishing using sodium bicarbonate (Air Flow Classic powder); Group 5: HI followed by air polishing using erythritol (Air Flow Plus powder); and Group 6: HI performed on teeth from non-smokers. Following each experiment, the surface roughness of the crown (RaC) and root (RaR) was measured. The samples were analyzed using a scanning electron microscope (SEM) combined with energy-dispersive X-ray analysis. Results. A total of 60 samples were analyzed, with 10 samples allocated to each group. The samples in Group 1 exhibited erosion areas with exposed enamel rod ends on the crown surfaces, while the root surfaces displayed resorption craters with exposed dentinal tubules. In the SEM analysis of the polishing methods, Group 2 displayed a relatively smooth surface characterized by the presence of deposits. Group 3 exhibited a distinctly irregular and rough surface, with exposed enamel rods and dentinal tubules. The air polishing groups displayed scratches on the enamel surfaces, whereas the root surfaces displayed a smooth texture with minimal debris. Significant differences were observed among the groups in terms of RaC and RaR (p = 0.016). The lowest mean RaC value was recorded in Group 6 (0.77 ± 0.11µm), while the highest was in Group 3 (1.36 ± 0.34 µm) (p = 0.005). Group 2 exhibited the lowest RaR value among all groups (0.89 ± 0.26 µm). Group 1 exhibited lower calcium levels on the enamel surface compared to Group 6 (p = 0.021). Conclusions. This study revealed that, following scaling, smokers’ teeth exhibited lower elemental levels, greater surface roughness, and areas of erosion and resorption compared to those of non-smokers. After smokers’ teeth were polished, the polishing paste group demonstrated the least surface roughness, while the air polishing groups showed higher mineral levels and a few debris particles

Community-Acquired Meningoencephalitis Caused by Acinetobacter lwoffii: A Rare Clinical Case

Introduction. Acinetobacter lwoffii is a rare cause of bacterial meningitis, particularly in immunocompetent individuals without prior healthcare exposure. To date, only a very limited number of cases have been documented in the literature. Case Report. A 17-year-old male patient presented with fever, severe headache, meningeal irritation, and neurological symptoms. Cerebrospinal fluid analysis revealed neutrophilic pleocytosis and elevated inflammatory markers. Phenotypic analysis with the Vitek 2C system identified the cerebrospinal fluid isolate as A. lwoffii. Empirical antibiotic therapy was initiated and subsequently adjusted based on sensitivity testing, improving clinical and laboratory parameters. Conclusions. This case highlights the pathogenic potential of A. lwoffii to cause severe central nervous system infections in healthy individuals. It emphasizes the importance of early microbiological diagnosis and targeted antibiotic therapy. The clinical picture, diagnostic approach, treatment strategy, and outcome are discussed in relation to the existing evidence

A Hybrid Approach to Modelling ECC Risk: Effectiveness of Nonparametric Regression and MLFNN Techniques

Introduction. Early childhood caries (ECC) is a prevalent dental condition that significantly impacts children’s quality of life and is influenced by both environmental and metabolic factors. Anthropometric variables such as weight, height, and body mass index serve as indicators of overall growth and nutritional status, which are closely linked to oral health. Additionally, family size may play a role in ECC risk by influencing dietary habits and oral hygiene practices. Despite these associations, the complex and nonlinear relationships between these factors and ECC risk remain insufficiently explored. This study aims to investigate the potential relationships between ECC risk and a combination of social (family size) and anthropometric parameters (weight, height, and body mass index) by employing nonparametric regression and validating these relationships with a multilayer feed-forward neural network (MLFNN). Methods. This cross-sectional observational study utilized secondary data from Universiti Sains Malaysia Hospital, Kota Bharu, Kelantan, Malaysia. The dataset was divided into training (60%), testing (30%), and validation (10%) subsets. A generalized additive model (GAM) was used to capture nonlinear relationships, followed by MLFNN validation. Model performance was assessed using root mean squared error (RMSE), mean absolute error (MAE), median absolute error (MedAE), and mean squared error (MSE). Results. The dataset exhibited non-normality, justifying the use of nonparametric regression. In the GAM, only weight showed a nonlinear relationship, with no other predictors significantly influencing ECC risk, except for the intercept. The MLFNN achieved an error value of 0.089 and an accuracy of 91.09%, with height contributing the most to ECC risk estimation. Conclusions. Integrating nonparametric regression and MLFNN validation provides a robust framework for modelling ECC risk, capturing complex nonlinear relationships between family size and anthropometric factors. Height emerged as the most influential predictor, highlighting its association with growth and systemic health, followed by weight, body mass index, and family size. These findings underscore the need for a multifactorial approach in ECC prevention, emphasizing nutritional and family-related factors in pediatric dental care

Effectiveness of Oral Nutrition Supplements in Older Patients: Evidence Versus Challenges

The increasing population of older adults imposes a significant burden and expenditures on healthcare services. Malnutrition is frequently associated with chronic diseases in older patients. Oral nutritional supplements (ONS) are crucial in managing malnutrition in older adults who need nutritional support. However, challenges related to low adherence may limit the effectiveness of ONS. This narrative review focuses on the difficulties associated with ONS use and the evidence regarding its efficacy in older patients. Studies have reported that ONS can be an effective strategy for nutritional interventions to prevent weight loss by supporting an increase in total food consumption. In addition, ONS have shown positive effects on walking speed and muscle strength in older adults. While the evidence for the positive impact of ONS on enhanced appetite, improved energy intake, and body weight in older patients at risk of malnutrition is well documented, concerns about inadequate consumption, taste and texture dissatisfaction, and low adherence have also been noted. Poor adherence to nutritional therapy may place older patients at risk of medical complications, rehospitalizations, and interruptions in nutritional care. Future qualitative and mixed-method research focused on improving the reporting and follow-up of ONS adherence and understanding the factors influencing acceptance in older patients will strengthen the existing literature and provide valuable guidance for healthcare teams in increasing adherence.  &nbsp