Treatment outcome in children with non-syndromic unilateral cleft lip and palate based on congenital and postnatal treatment factors: a multi-population study using threedimensional digital models

This cross-sectional study aimed to evaluate dental arch relationship (DAR) and maxillary arch dimension (MAD) of non-syndromic unilateral cleft lip and palate (UCLP) children and to explore the congenital (gender, UCLP type, UCLP side, family history of cleft, family history of Class III malocclusion) and postnatal treatment (types of cheiloplasty and palatoplasty) factors that affect the treatment outcome of UCLP children using laser scanned three-dimensional digital models (LS3DM). Furthermore, the present study evaluated and compared the mesiodistal (MD) tooth sizes on cleft side (CS) and non-cleft side (NCS) of the maxilla among male and female UCLP children using LS3DM as well as evaluated the association among gender and races. Two hundred and fifty-five pretreatment orthodontic plaster dental casts of UCLP children from Malaysia, Bangladesh, and Pakistan populations, 85 from each were selected into this study. The mean age was 7.69± 2.46 (mean± SD). All the dental casts were scanned and converted into LS3DM by Next Engine laser scanner (Santa Monica, USA). DAR was assessed by two raters using GOSLON Yardstick (GY) and EUROCRAN index (EI) and modified Huddart Bodenham (mHB) scoring system. Inter-canine width (ICW), inter-molar width (IMW), arch depth (AD) and MD dimensions of the tooth were measured with Mimics software (Belgium). Treatment outcome was rated into two groups; favourable and unfavourable groups based on GY, EI and mHB scoring systems. Kappa statistics used to evaluate the intra- and interexaminer agreements and logistic regression analysis (LRA) used to explore the responsible factor that affect DAR. The intra-class correlation was used to evaluate the intra- and inter-examiner agreements and multiple linear regression analyses used to evaluate the association between multiple factors and MAD (ICW, IMW, and AD) and MD dimension of tooth size of the maxilla. p-value was set at 5%. The mean GY score was 2.97, 3.40 and 3.09 in Malaysia, Bangladesh and Pakistan population respectively. Unfavourable DAR was significantly associated with Bardach technique (BT) of palatoplasty (p = 0.03) in Malaysian, male UCLP subjects (p = 0.03), modified Millard technique (MMT) of cheiloplasty (p = 0.04) and BT of palatoplasty (p = 0.04) in Bangladeshi and BT of palatoplasty (p = 0.04) in Pakistani population using GY. The mean EUROCRAN scores were 3.07 and 2.21 in Malaysia, 2.66 and 2.07 in Bangladesh and 2.56 and 2.07 in Pakistan for DAR and palatal morphology (PM) respectively. Using LRA, unfavourable DAR was significantly associated with positive family history of cleft (p = 0.03) and BT of palatoplasty (p < 0.001) in Malaysian, MMT of cheiloplasty (p = 0.010) and BT of palatoplasty (p = 0.02) in Bangladeshi and left sided UCLP (p = 0.03), MMT of cheiloplasty (p = 0.02) and BT of palatoplasty (p = 0.04) in Pakistani population using EI. The total mHB score was -9.98, -8.76 and -6.57 in Malaysia, Bangladesh and Pakistan population respectively. Using LRA, unfavourable DAR was significantly associated with positive family history of cleft (p = 0.02 and p = 0.04) and BT of palatoplasty (p = 0.03 and p = 0.01) in Malaysian and Bangladeshi population respectively, and BT of palatoplasty (p < 0.001) in Pakistani population. The mean dimension of ICW was 26.88 mm, 26.61 mm and 26.69 mm and IMW was 45.24 mm, 42.89 mm and 43.33 mm and AD was 29.81 mm, 29.06 mm and 27.06 mm in Malaysians, Bangladeshis and Pakistanis respectively. Significant association was observed between narrower ICW and MMT of cheiloplasty (p < 0.001) in Malaysian and BT of palatoplasty (p = 0.04 and p = 0.02) in Malaysian and Bangladeshi population respectively. Significant association was observed between shorter AD and complete type of UCLP (p = 0.01) in Bangladeshi. Regarding tooth size asymmetry, significant difference observed in MD dimension of all the teeth size of CS and NCS of maxillae among male and female in all populations. This multi-population study suggested that treatment outcome based on DAR and MAD of non-syndromic Malaysians, Bangladeshis and Pakistanis UCLP children was significantly correlated with some of congenital and postnatal treatment factors using LS3DM. The study also revealed significantly smaller teeth size in CS compare to NCS in relation to gender, and races in all populations using LS3DM

Dental arch relationship in Bangladesh children with non-syndromic unilateral cleft lip and palate(UCLP)

Cleft lip and palate (CLP) is one of the most common birth defects. Multiple factors are believed to be responsible for an unfavorable dental arch relationship (DAR) in CLP. Facial growth (maxillary) retardation, which results in class III malocclusion, is the primary challenge that CLP patients face. Congenital factors (UCLP type, UCLP side, family history of cleft, family history of class III) and postnatal treatment factors (cheiloplasty, palatoplasty) may influence treatment outcomes in unilateral cleft lip and palate (UCLP) children, which has led to a great diversity in protocols and surgical techniques by various cleft groups worldwide. The aim of this retrospective study was to evaluate DAR of non syndromic Bangladeshi UCLP children and to explore the various congenital and postnatal treatment factors that are responsible for unfavorable DAR. Eighty four dental models were taken before orthodontic treatment and alveolar bone grafting. The mean age was 7.69± 2.46 (mean± SD). All the subjects had primary surgery (cheiloplasty and palatoplasty) at the same hospital. DAR was assessed blindly by five raters using GOSLON Yardstick (GY) and EUROCRAN index (EI) and by two raters using modified Huddart Bodenham (mHB) scoring system. Furthermore, all the subjects were divided into two groups; favorable and unfavorable groups. This grouping was carried out because patients in the favorable groups may not need further treatment after palatoplasty or cheiloplasty or they could be treated with conventional orthodontics, whereas patients in the unfavorable groups sometimes required surgical correction. Kappa statistics was used to evaluate the intra- and interexaminer agreements, chi square was used to assess the associations and logistic regression analysis was used to explore the responsible factors that affect DAR. Total 37 subjects (44% of all subjects) were categorized into unfavourable group (category rating 4 and 5) using GY.The mean GOSLON score was 3.238. Intra- and inter-examiner agreements were very good. Using crude and stepwise backward regression analysis, significant association was found between family history of skeletal class III malocclusion (p = 0.015 and p = 0.014 respectively) and unfavourable DAR. Complete UCLP (p = 0.054) and left sided UCLP (p = 0.053) also seemed to be correlated with unfavourable DAR using crude and stepwise backward regression analysis respectively but no significant associations was found. Total 47 subjects (56% of all subjects) were categorized into unfavourable group (category rating 3 and 4) using EI. The mean EUROCRAN scores were 2.44 and 1.93 for DAR and palatal morphology (PM) respectively. Intra- and inter-examiner agreement was good to very good. Using crude and stepwise backward regression analyses, significant associations were found between the modified Millard technique (p = 0.047, p = 0.034 respectively) of cheiloplasty and unfavorable DAR. Complete UCLP (p = 0.017) was also significantly correlated with unfavorable DAR. The PM showed a significant association with the type of cleft, type of cheiloplasty and type of palatoplasty. Total 39 subjects (46% of all subjects) were categorized into unfavourable group (category ratings poor and very poor) using mHB scoring system. The total mHB score was -8.26. Intra- and inter-agreement was very good. Using crude and stepwise backward regression analysis, significant association was found between positive history of class III (p = 0.025, p = 0.030 respectively) and unfavorable DAR. Using chi square test, complete UCLP (p = 0.003) and V-Y pushback palatoplasty (p = 0.005) were also significantly correlated with unfavorable DAR. This multivariate study suggested that DAR of non syndromic Bangladeshi UCLP children was significantly correlated with some of congenital and postnatal treatment factors by using different indices

Preparation and Characterization of Jute Cellulose Crystals-Reinforced Poly(L-lactic acid) Biocomposite for Biomedical Applications

Crystalline cellulose was extracted from jute by hydrolysis with 40% H2SO4 to get mixture of micro/nanocrystals. Scanning electron microscope (SEM) showed the microcrystalline structure of cellulose and XRD indicated the Iβ polymorph of cellulose. Biodegradable composites were prepared using crystalline cellulose (CC) of jute as the reinforcement (3–15%) and poly(lactic acid) (PLA) as a matrix by extrusion and hot press method. CC was cellulose derived from mercerized and bleached jute fiber by acid hydrolysis to remove the amorphous regions. FT-IR studies showed hydrogen bonding between the CC and the PLA matrix. The X-ray diffraction (XRD) and differential scanning calorimetry (DSC) studies showed that the percentage crystallinity of PLA in composites was found to be higher than that of neat PLA as a result of the nucleating ability of the crystalline cellulose. Furthermore, Vicker hardness and yield strength were found to increase with increasing cellulose content in the composite. The SEM images of the fracture surfaces of the composites were indicative of poor adhesion between the CC and the PLA matrix. The composite with 15% CC showed antibacterial effect though pure films but had no antimicrobial effect; on the other hand its cytotoxicity in biological medium was found to be medium which might be suitable for its potential biomedical applications

Elastic scattering of electrons and positrons from In-115 atoms over the energy range 1 eV-0.5 GeV

We present a theoretical study on the calculations of various cross sections related to the scattering of electrons and positrons from indium atoms. Our calculations cover the energy range 1 eV <= E-i <= 0.5 GeV. We have employed two approaches, applicable for two domains of energy, based on the Dirac partial-wave analysis. In one approach, we have used both the atomic and nuclear potentials to calculate the cross sections for the low and intermediate energies. The other approach, valid for the high-energy scattering, utilizes only the nuclear potential for the phase-shift analysis, and considers the magnetic scattering from the nucleus too. We report the calculations of differential, integral, momentum-transfer and viscosity cross sections along with the spin asymmetries for the elastic scattering of electrons and positrons. Moreover, we have analyzed the critical minima in the elastic differential cross sections, and also computed the absorption and total cross sections. Our results agree reasonably with the available experimental data and other calculations

Soft Tissue Cephalometric Measurements Among Malaysian Malays and Chinese

Objective: To obtain the standardized values of individuals of Malaysian Malay and Chinese for further relevant research, such as treatment planning and aesthetical considerations. Material and Methods: In this retrospective study, 440 (305 were Malays and 135 were Chinese) standardized lateral cephalometric radiographs of orthodontic patients selected through simple random sampling are profiled using Holdaway’s analysis. The independent t-test was used to assess the disparities in race and gender. The significant level was p&lt;0.05. Results: Significant differences were found between the Malays and Chinese in their skeletal profile convexity, superior sulcus depth, inferior sulcus to the H line and nose prominence. Between Malay females and males, there are significant differences in superior sulcus depth, soft tissue subnasale to H line, basic upper lip thickness, upper lip thickness and nose prominence. Between Chinese males and females, there were differences in their skeletal profile convexity, upper lip to H line, basic upper lip thickness and upper lip thickness. Conclusion: The findings demonstrated the difference between standardized norms and the unique profiles of Malaysian Malays and Chinese. There are significant gender disparities in the soft tissue cephalometric measurements among Malaysian Malay and Chinese subjects

Multisystem inflammatory syndrome of a neonate from a COVID-19-infected mother : a case report

In neonates, the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 – COVID-19) is lower. There is the potential for vertical transmission of SARS-CoV-2. To date, only a few reports suggest this possibility. Neonates usually have mild symptoms, but some develop multisystem involvement, which is a concern. COVID-19 infections have been reported both in pregnant women and their neonates. However, the evidence of vertical or horizontal transmission modes has not been fully established. We recorded a case study where a 33-year-old mother was tested positive for COVID-19 infection by RT-PCR during her 27th week of gestation and needed ventilator support for her respiratory distress at that time for 11 days. Subsequently, she gave birth to a female baby at the 35th week via a lower uterine segment cesarean section. The neonate manifested a severe multisystem inflammatory syndrome associated with her possible COVID-19 infection. Sharing her uncommon clinical presentation, immunological syndrome, and disease outcome are noteworthy for similar unforeseen pediatric case management to help guide future investigations and car

Sagittal jaw relationship of different types of cleft and non-cleft individuals

To investigate whether the craniofacial sagittal jaw relationship in patients with non-syndromic cleft differed from non-cleft (NC) individuals by artificial intelligence (A.I.)-driven lateral cephalometric (Late. Ceph.) analysis. The study group comprised 123 subjects with different types of clefts including 29 = BCLP (bilateral cleft lip and palate), 41 = UCLP (unilateral cleft lip and palate), 9 = UCLA (unilateral cleft lip and alveolus), 13 = UCL (unilateral cleft lip) and NC = 31. The mean age was 14.77 years. SNA, SNB, ANB angle and Wits appraisal was measured in lateral cephalogram using a new innovative A.I driven Webceph software. Two-way ANOVA and multiple-comparison statistics tests were applied to see the differences between gender and among different types of clefts vs. NC individuals. A significant decrease (p 0.005) showed insignificant variables in relation to type of clefts. No significant difference was also found in terms of gender in relation to any type of clefts and NC group. The present study advocates a decrease in sagittal development (SNA, ANB and Wits appraisal) in different types of cleft compared to NC individuals

A low cost, sustainable, locally delivered intervention to promote exclusive breastfeeding practices in rural Bangladeshi women

Background: Breastfeeding is a well-accepted customary practice in Bangladesh. However, there are barriers to exclusive breastfeeding including the tradition of potentially harmful practices such as prelacteal feeding (PF) and early additional feeding (ADF). Most breastfeeding promotion programmes are unable to support mothers in rural areas who deliver at home, assisted by locally practiced dai or a traditional birth attendant (TBA). With adequate training and knowledge in optimum infant feeding, TBAs could establish a locally acceptable and sustainable custom of breastfeeding practices amongst mothers in rural areas. Methods: A controlled trial was conducted in the Dohar Upazila of Dhaka district to evaluate the impact of a TBA-led education intervention on early and exclusive breastfeeding practices in the first six months post-natally. Two community clinics (CCs) were selected as the intervention and control centres respectively. TBAs were trained to deliver breastfeeding and infant feeding advice to mothers, both pre- and post-natally. Demographic characteristics were collected via questionnaires. Infant weight, length, BMI and age were recorded across four clinic visits between birth and 5-6 months and converted to z-scores using WHO growth references. Where possible, infant birth weight was recorded. Infant feeding histories were collected via questionnaires together with reported occurrences of infant illnesses. Results: A total of 269 mothers were recruited during 2014-2015, of whom 265 mothers with a mean age of 23.6±5.0 years completed the final 5-6 months of follow-up. The majority of mothers (78.3%) either had received primary education or were uneducated. More than 96% stayed at home and 43.4% were pregnant for the first time. Significantly more mothers (86.8%) in the intervention group breastfed their infants within the first hour post-natally compared to 31.5% in the control group (p<0.0001). 8.3% of infants in the intervention group received PF in the first week compared to 82.3% in the control group (p<0.0001). Significantly more mothers (78.6%) in the intervention group exclusively breastfed between birth and 5-6 months post-natally compared to 29.2% in the control group (p<0.0001). The intervention tended to show better outcomes for the infants with respect to z-weight, z-length and z-BMI up to age 5-6 months, although statistical significance varied at time points and between anthropometric measurements. Infants in the intervention group tended to present with fewer illnesses across the study period compared to the control group. Conclusion: The study successfully found that the TBA-led breastfeeding education intervention resulted in better outcomes for infant feeding, growth and illness. It is likely that the better infant growth and illness resulted from improved breastfeeding practice. These findings suggest that the training of local TBAs could lead to a low cost and sustainable way to promote exclusive breastfeeding practices in rural Bangladeshi women which feasibly could be extended across the country

Analysis of Supporting Structure of a Pressure Vessel Installed in Open Air: an Industrial Case Study

Tall structures, installed in the open air are prone to wind load. Depending on the geometry of the structure, its support at the ground level and the intensity of the wind, the wind load analysis can be a significant factor from the safety point of view. Especially, in case of a pressure vessel, such as a water tank or any chemical container. In the current study, only the effects of vibration on these structures have been focused. Several factors influence the lateral natural frequency of the structure. The aspect ratio (height versus width), nature of support at the base, supporting leg lengths and their counts, the geometry of the leg supports, the mass of the vessel, are some influencing factors. Supporting legs are designed based on the compressive and buckling failures, and standard tube structures have been adopted. Aspect ratios considered here varies as 2, 3, and 4 which confirms most of the practical applications. There are several cases in the past where the vortex shedding frequency under steady wind velocity came close to the natural frequency of the structure and caused failure. Hence, in this study, we tried to predict the critical wind speed for which structure is prone to failure due to the resonating condition. The vortex shedding frequency depends on the steady wind speed, equivalent diameter of the pressure vessel and Strouhal and Reynolds numbers. Our analysis was carried out using SolidWorks and ANSYS. The results can be used as a guideline for the design of pressure vessel installed in the open air to avoid the resonating effect. For a case study, mechanical analysis of a provided design for a pressure vessel from the Johnson and Matthey Process Technologies in Savannah, Georgia, was done for this research. Several models for the pressure vessel were devised and then compared by considering the cost, construction, accessibility, and sustainability. The analysis is focused on the strength of the support system as well as the stability of the pressure vessel itself under severe conditions. First, the analysis was based on the structural integrity of the of these supporting load cells under the fully loaded condition. Then the study was focused on the dynamic stability of the of the pressure vessel under constant wind load. Finally, these results are compared to show the consistency