Clinical studies of oral epithelial dysplasia

This study has investigated a number of aspects of the clinical presentation, aetiology and management of oral epithelial dysplasia (OED) in a large number of affected patients. The results reveal that the peak frequency for occurrence of OED is the 6th decade, a predilection for males was confirmed. The tongue, buccal mucosa and floor of mouth are the most common sites of involvement. Most OED is mild; carcinoma-in-situ is rare, the sites likely to have areas of severe dysplasia are the floor of mouth and lateral border of tongue. There is a positive association between heavy tobacco smoking, especially non-filter cigarettes and risk of OED, although the risk may decline following cessation of smoking. In non-smokers, consumption of alcohol is not a significant predictor of OED but there is interaction between alcohol and some aspects of tobacco smoking. The relative risk associated with tobacco smoking appeared to be highest for OED of the labial mucosa and floor of mouth in males and tongue and floor of mouth in females. While alcohol drinking is not a significant predictor of specific OED subsites in both males and females. OED may occur in nonusers of tobacco and alcohol, these patients tend to be older women presenting with erythroleukoplakic type lesions. There is a significant association between reduced serum folate, red blood cell folate and risk of OED. Infectious agents such as Candida albicans may have a slight significance in the aetiology of OED but infection with hepatitis C virus or Helicobacter pylori are not significantly associated with OED. Follow-up of these patients with OED suggest that 5.5% of patients develop oral squamous cell carcinoma while 10.3% develop a second dysplastic lesion and 17.5% develop recurrence. It is evident that dental practitioners have some knowledge and experience of oral malignancy and premalignancy but they may fail to recognise appropriate signs and symptoms of such disease, do not always provide appropriate preventive advice and may delay referral of patients to appropriate centres

Dental caries experience, oral health status and treatment needs of dental patients with autism

OBJECTIVES: Autism is a lifelong neurodevelopmental disorder. The aims of this study were to investigate whether children with autism have higher caries prevalence, higher periodontal problems, or more treatment needs than children of a control group of non-autistic patients, and to provide baseline data to enable comparison and future planning of dental services to autistic children. MATERIAL AND METHODS: 61 patients with autism aged 6-16 years (45 males and 16 females) attending Dubai and Sharjah Autism Centers were selected for the study. The control group consisted of 61 non-autistic patients chosen from relatives or friends of autistic patients in an attempt to have matched age, sex and socioeconomic status. Each patient received a complete oral and periodontal examination, assessment of caries prevalence, and caries severity. Other conditions assessed were dental plaque, gingivitis, restorations and treatment needs. Chi-square and Fisher's exact test of significance were used to compare groups. RESULTS: The autism group had a male-to-female ratio of 2.8:1. Compared to controls, children with autism had significantly higher decayed, missing or filled teeth than unaffected patients and significantly needed more restorative dental treatment. The restorative index (RI) and Met Need Index (MNI) for the autistic children were 0.02 and 0.3, respectively. The majority of the autistic children either having poor 59.0% (36/61) or fair 37.8% (23/61) oral hygiene compared with healthy control subjects. Likewise, 97.0% (59/61) of the autistic children had gingivitis. CONCLUSIONS: Children with autism exhibited a higher caries prevalence, poor oral hygiene and extensive unmet needs for dental treatment than non-autistic healthy control group. Thus oral health program that emphasizes prevention should be considered of particular importance for children and young people with autism

Clinical Characteristics of COVID-19 Infection

The typical clinical symptoms of the patients who suffered from the novel viral pneumonia were fever, cough, and myalgia or fatigue with abnormal chest CT, and the less common symptoms were sputum production, headache, hemoptysis, and diarrhea. This new infectious agent is more likely to affect older males to cause severe respiratory diseases. Major risk factors for severe illness and mortality from COVID-19 are age, comorbidities such as: heart disease, hypertension, prior stroke, diabetes, chronic lung disease, and chronic kidney disease and associated with adverse outcomes. Loss of taste and smell preceding the onset of respiratory symptoms has been reported

Comparative Study of Using Sea-Water for Enhanced Oil Recovery in Carbonate and Sandstone Reservoirs: Effects of Temperature and Aging Time on Oil Recovery

Oil recovery process is an essential element in the oil industry, in this study, a laboratory study to investigate the effect of temperature and aging time on oil recovery and understand some of the mechanisms of seawater in the injection process. In order to do that, the sandstone and carbonate cores were placed in the oven in brine to simulate realistic reservoir conditions. Then, they were aged in crude oil in the oven. After that, they were put in the seawater to recover, and this test is called a spontaneous imbibition test. The spontaneous imbibition test in this study was performed at room temperature to oven temperature 80 oC with different sandstone and carbonate rock with aging time of 1126 hours. The result shows that the impact of seawater on oil recovery in sandstone is higher than carbonate. At higher temperature, the oil recovery is more moderate than low temperature. Likewise, as the aging time increase for both sandstone and carbonate rocks the oil recovery increase.&nbsp

Analysis of Partial Electrocoalescence by Level-Set and Finite Element Methods

The coalescence of a water drop in a dieletric oil phase at a water layer interface in the presence of an electric field is simulated by solving the Navier-Stokes and charge conservation equations with the finite element method. The proprietary software Comsol Multiphysics is used for this purpose. The interface between the oil and water phases is tracked by implementing a level-set approach. Preliminary simulations to assess the sensitivity of the model with respect to some input parameters are reported. In particular, the calculations are very sensitive to the size of the computational grid elements and the interface thickness parameter. Nevertheless, the model is able to reproduce the occurrence of partial coalescence for the experimental case examined. Good quantitative agreement can be obtained if the parameters are suitably tuned.qscienc

Overview on Epidemiology and Management of Myxedema Coma or Crisis

The most severe type of hypothyroidism is known as myxedema coma, which can quickly lead to death if not identified and treated aggressively. The condition known as hypothyroidism is easily detected and treated. But if ignored, it might eventually progress to myxedema coma, the most serious form of hypothyroidism. Since the majority of patients do not initially appear in a coma, the term "myxedema coma" is usually regarded as misleading. Lethargy usually progresses to stupor, which then becomes a coma with hypothermia and respiratory failure. only clinical criteria are used for diagnosis because thyroid hormone assays are unable to distinguish between simple hyperthyroidism and thyroid storm. Apart from essential medical interventions, the treatment focuses on preventing thyroid hormone production and secretion as antithyroid medications, and preventing the peripheral effects of thyroid hormone as β-blocker, glucocorticoids. The diagnosis of thyroid-stimulating hormone (TSH) in the blood is the same as that of simple hypothyroidism. As soon as a diagnosis is obtained, treatment should start right away. The majority of hospital and commercial laboratories can turnaround a TSH test in a matter of hours

A multi-country study on the impact of sex and age on oral features of COVID-19 infection in adolescents and young adults

Background: Oral diseases are features of COVID-19 infection. There is, however, little known about oral diseases associated with COVID-19 in adolescents and young adults (AYA). Therefore, the aim of this study was to assess oral lesions’ association with COVID-19 infection in AYA; and to identify if sex and age will modify these associations. Methodology: Data was collected for this cross-sectional study between August 2020 and January 2021 from 11-to-23 years old participants in 43-countries using an electronic validated questionnaire developed in five languages. Data collected included information on the dependent variables (the presence of oral conditions- gingival inflammation, dry mouth, change in taste and oral ulcers), independent variable (COVID-19 infection) and confounders (age, sex, history of medical problems and parents’ educational level). Multilevel binary logistic regression was used for analysis. Results: Complete data were available for 7164 AYA, with 7.5% reporting a history of COVID-19 infection. A significantly higher percentage of participants with a history of COVID-19 infection than those without COVID-19 infection reported having dry mouth (10.6% vs 7.3%, AOR = 1.31) and taste changes (11.1% vs 2.7%, AOR = 4.11). There was a significant effect modification in the association between COVID-19 infection and the presence of dry mouth and change in taste by age and sex (P = 0.02 and < 0.001). Conclusion: COVID-19 infection was associated with dry mouth and change in taste among AYA and the strength of this association differed by age and sex. These oral conditions may help serve as an index for suspicion of COVID-19 infection in AYA

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication