Untreated severe dental decay: a neglected determinant of low Body Mass Index in 12-year-old Filipino children

Contains fulltext : 98500.pdf (publisher's version ) (Open Access)BACKGROUND: Dental decay is the most common childhood disease worldwide and most of the decay remains untreated. In the Philippines caries levels are among the highest in the South East Asian region. Elementary school children suffer from high prevalence of stunting and underweight.The present study aimed to investigate the association between untreated dental decay and Body Mass Index (BMI) among 12-year-old Filipino children. METHODS: Data collection was part of the National Oral Health Survey, a representative cross-sectional study of 1951 11-13-year-old school children using a modified, stratified cluster sampling design based on population classifications of the Philippine National Statistics Office. Caries was scored according to WHO criteria (1997) and odontogenic infections using the PUFA index. Anthropometric measures were performed by trained nurses. Some socio-economic determinants were included as potential confounding factors. RESULTS: The overall prevalence of caries (DMFT + dmft > 0) was 82.3% (95%CI; 80.6%-84.0%). The overall prevalence of odontogenic infections due to caries (PUFA + pufa > 0) was 55.7% (95% CI; 53.5%-57.9%) The BMI of 27.1% (95%CI; 25.1%-29.1%) of children was below normal, 1% (95%CI; 0.5%-1.4%) had a BMI above normal. The regression coefficient between BMI and caries was highly significant (p 0) as compared to those without odontogenic infections had an increased risk of a below normal BMI (OR: 1.47; 95% CI: 1.19-1.80). CONCLUSIONS: This is the first-ever representative survey showing a significant association between caries and BMI and particularly between odontogenic infections and below normal BMI. An expanded model of hypothesised associations is presented that includes progressed forms of dental decay as a significant, yet largely neglected determinant of poor child development

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Thresholds of Abnormality Perception in Facial Esthetics among Laypersons and Dental Professionals: Frontal Esthetics

Aim. To find thresholds at which laypersons and dental professionals perceive abnormalities in two facial frontal esthetics variables: facial symmetry and vertical harmony. Materials and Methods. A baseline frontal image of a young male face with optimum facial proportions was generated from a real image using a photo editing software. Different facial asymmetry images were then generated from this image by manipulating the chin point position at 2 mm increment to the left side. Vertical harmony was perceived through manipulating lower anterior facial height (LAFH) at a ratio of 2% of increased and decreased heights. A total of 120 raters divided equally into four groups of laypersons, general dental practitioners (GDPs), orthodontists, and oral and maxillofacial surgeons (OMFSs) rated these images using an analog scale of 100 mm long. Using ANOVA and Tukey post hoc tests at P<0.05, the image that showed the first statistical difference compared to the baseline was considered as a threshold of abnormality. Results. The image of 4 mm asymmetry was defined by the laypersons and GDPs as the threshold of abnormality, while the orthodontists and OMFSs realized that at 2 mm. Laypersons and GDPs defined a threshold of 46% as an abnormal decrease in the LAFH and the other 2 groups at 48%. All dental professionals groups rated the image of 54% as an abnormal increase in the LAFH while laypersons perceived that at 56%. Conclusion. These thresholds regarding frontal esthetics may contribute to the process of establishing proper orthodontic treatment planning that suits the highest facial esthetic standards

Thresholds of Abnormality Perception in Facial Esthetics among Laypersons and Dental Professionals: Profile Esthetics

Aim. To find thresholds at which laypersons and dental professionals from Jordanian population perceive abnormalities in sagittal positioning of upper and lower jaws as a major determinant to facial profile esthetics. Materials and Methods. Using photo editing software, a baseline profile image of a young male was manipulated on a 2 mm incremental basis to move each of the upper and lower jaws backward and forward relative to true vertical line (TVL) at which four variables of maxillary and mandibular retrusion and protrusion were researched. A total of 120 participants divided equally into four groups of laypersons, general dental practitioners (GDPs), orthodontists, and oral and maxillofacial surgeons (OMFSs) rated the images using an analog scale of 100 mm long. The image that showed the first statistical difference compared to the baseline was considered as a threshold of abnormality. Results. Laypersons, GDPs, and OMFSs perceived the abnormality in the maxillary retrusion at −5 mm to TVL, while orthodontists defined that at −3 mm. All dental professionals perceived the abnormality in the maxillary protrusion at +1 mm to TVL while the layperson group at +3 mm. A threshold of −7 mm mandibular retrusion to TVL was abnormally perceived by all groups. All dental professionals realized the abnormality in the mandibular protrusion at 0 mm to TVL while the laypersons at +2 mm. Conclusion. These thresholds regarding profile esthetics may contribute to the process of establishing proper orthodontic treatment planning that suits the highest facial esthetic standards

Modular Synthesis of Polar Spirocyclic Scaffolds Enabled by Radical Chemistry

Exploration of three-dimensional structural space has become crucial for the development of novel bioactive molecules. In this context, polar spirocycles have emerged as key scaffolds due to their enhanced 3D character and well-defined spatial orientation. Herein, we report the development of a highly modular strategy to access beta-spirocyclic pyrrolidine derivatives from readily available starting materials, i.e., cyclic ketones and amino or oxamic acids. The sequence proceeds through a straightforward Knoevenagel condensation, followed by a domino Giese-type reaction/base-mediated cyclisation process, delivering a broad scope of polar spirocyclic scaffolds in good to excellent yields. The products can be readily diversified to access a wider range of spirocyclic cores (such as lactams or succinimides), thus increasing the versatility of our method to gain rapid access to libraries of potential drug-like molecules

The role of repeat fine needle aspiration in managing indeterminate thyroid nodules

Abstract Background The Bethesda System is the most widely used for reporting fine needle aspiration (FNA) cytology. It recommends a repeat FNA (rFNA) when initial results are category I or III. It is unclear how often rFNA provides additional diagnostic information. We sought to investigate its utility at our institution. Methods A retrospective chart review was performed of patients who had a category I or III FNA result and underwent rFNA of the same thyroid nodule between 2013 and 2015 at the QE II Health Sciences Centre in Nova Scotia, Canada. Results of initial FNA and ultrasound characteristics, rFNA, demographic data, surgical details, and pathology were collected. Results A total of 237 patients (474 thyroid FNAs) were included. Most initial FNAs were category I (82%), the remainder category III (18%). rFNA yielded a different category 60% of the time. However, 60% remained category I or III. rFNA results of benign or malignant were found in 40% of cases; 1% were SFN/SFM. Twenty-seven percent of patients had surgery after rFNA; of those 68% had category I or III rFNA results. Of all nodules that underwent surgery, 46% were malignant, including 32% with category I rFNA results, and 42% category III. Conclusions rFNA for category I and III nodules provided a definitive diagnosis in only 40% of cases, which is important for patient counseling. Malignancy rates at our centre were higher for these categories than predicted by Bethesda. Clinical management should consider institution specific malignancy rates, patient factors, and ultrasound findings

Performance Evaluation of Polyethersulfone Membranes for Competitive Removal of Cd2+, Co2+, and Pb2+ Ions from Simulated Groundwater

This paper presents studying the performance of three types of polyethersulfone (PES) membrane for the simultaneous removal of Co2+ ions, Cd2+ ions, and Pb2+ ions from binary and ternary aqueous solutions. Co2+ ions, Cd2+ ions, and Pb2+ ions with two different initial concentrations (e.g., 10 and 50 ppm) were selected as examples of heavy metals that contaminate the groundwater as a result of geological and human activities. This study investigated the effect of types of PES membrane and metal ions concentration on the separation process. For the binary aqueous solutions, the permeation flux of the PES2 membranes was higher for the separation process of solutions containing 50 ppm of Cd2+ ions and 10 ppm of Co2+ ions (24.7 L/m2·h) and Pb2+ ions (23.7 L/m2·h). All the metals in the binary solutions had high rejection when their initial concentration was lower than the initial concentration of the other metal present in the same solution. Using PES2, the maximum rejection of Cd2+ ions was 61.3% when the initial concentrations were 50 ppm Pb2+ ions: 10 ppm Cd2+ ions and 55.4% for Pb2+ ions when the initial concentrations were 10 ppm Pb2+ ions: 50 ppm Cd2+ ions. For the ternary aqueous solutions, the rejection and the permeation flux of the PES membranes increased with decreasing the heavy metal initial concentration. Using PES2, the maximum permeation flux was 21.6 L/m2·h when the initial concentration of the metals was 10 ppm; and the maximum rejection of the metals obtained at initial concentration of 10 ppm was 50.5% for Co2+ ions, 48.3% for Cd2+ ions, and 40% for Pb2+ ions. The results of the filtration process using PES2 of simulated contaminated-groundwater indicated the efficient treatment of groundwater containing Co2+, Cd2+, and Pb2+ ions

Patient and tumor factors contributing to distant metastasis in well-differentiated thyroid cancer: a retrospective cohort study

Abstract Background Distant metastasis in thyroid cancer significantly reduces survival in patients with well-differentiated thyroid carcinoma (WDTC). There is limited information available to clinicians regarding pathological features that confer a higher risk of distant metastasis (DM). This study aimed to identify patient and tumor factors that were associated with the development of DM over time in patients with WDTC. Methods A retrospective cohort analysis of patients with WDTC (n = 584) at our institution was performed between 2007 and 2017. A total of 39 patients with DM and 529 patients with no DM (NDM) were included. Patient demographics, tumor characteristics and patient survival were compared between the DM and NDM groups using a univariate analysis. Multivariate Cox-proportional hazards model was used to evaluate the risk of developing distant metastasis over time. Kaplan-Meier analysis was used to compare survival between the DM and NDM groups. Results Distant metastasis had a substantial impact on disease-specific survival (DSS) at 5 and 10-years in the DM group; 71.0% (SE 8.4%) and 46.9% (SE 11.6%) respectively, compared to 100% survival in the NDM group (p < 0.001). The DM group had significantly higher proportions of males, lymphovascular invasion (LVI), nodal metastasis (NM), large tumor size (TS), extrathyroidal extension (ETE), positive resection margins, multifocality, follicular thyroid cancer (FTC), tall cell variant of papillary thyroid cancer (PTC), and Hurthle cell carcinoma (HCC), when compared to the NDM group (p < 0.05). A TS ≥ 2 cm (Hazard Ratio (HR) 1.370), NM (HR 3.806) and FTC (HR 7.068) were associated with a significantly increased hazard of developing distant metastasis in patients with WDTC. Conclusions TS ≥ 2 cm, NM and FTC are associated with a significantly increased propensity for developing DM in our cohort of WDTC patients. Graphical abstrac