Cone beam computed tomography evaluation of midpalatal suture maturation in a select Western Cape sample

Magister Scientiae Dentium - MSc(Dent)There is controversy in the literature regarding the ideal treatment timing for rapid maxillary expansion. The successful use of rapid maxillary expansion (RME) has largely been limited to young patients with chronological age being a determinant of the patency of the midpalatal suture. However, there is consensus in the literature that chronological age is not a valid indicator of skeletal age. Additionally, conventional radiology and histology has revealed that the midpalatal suture may be patent in young adults (<25 years of age), with successful RME shown in these patients

Ideal treatment timing of orthodontic anomalies—a German clinical S3 practice guideline

Purpose Ideal treatment timing in orthodontics is controversially discussed depending on the type and extent of the dysgnathia and malocclusion present, especially with regard to efficiency, patient burden and treatment efforts of early compared to regular or late treatment. This German clinical practice guideline aims to clarify, at which time points an orthodontic anomaly can be effectively treated and how treatment efficiency differs depending on treatment timing. Methods A systematic literature search was performed in various guideline databases and databases PROSPERO, MEDLINE (PubMed), Cochrane Library, Web of Science, ClinicalTrials.gov and the International Clinical Trials Registry Platform according to a predefined PICO (Population, Intervention, Comparison and Outcomes with added qualitative search terms) search algorithm and strategy. Appraisal of scientific evidence of the individual studies checked for eligibility was carried out according to SIGN (Scottish Intercollegiate Guidelines Network), AMSTAR II (Assessing the Methodological Quality of Systemic Reviews), and AXIS (Appraisal Tool to Assess the Quality of Cross-sectional Studies) tools. Only controlled studies with a high, acceptable or moderate quality (and thus an acceptable risk of bias) were considered. Results A total of 309 studies of over 11,000 sources screened were identified to be eligible for inclusion and critically appraised for study quality and risk-of-bias. No relevant guidelines relating to the aims of the present guideline were found. Elected delegates of in total 21 German scientific societies and organizations agreed upon a total of 19 evidence-based statements and recommendations based on a nominal consensus process. Conclusions Although most malocclusions can be effectively treated both in the early, late mixed, and permanent dentition, evidence suggests that therapy of a pronounced skeletal or dental class II anomaly can be started early to reduce the risk of dental anterior tooth trauma, whereas in a moderate class II anomaly, therapy can preferably be carried out before or during the pubertal growth peak. Therapy of a skeletal or dental class III anomaly should be started early, as this also reduces the need for later surgery to correct the anomaly. The treatment of a pronounced skeletal or dental transverse anomaly should be started early in the upper jaw in order to utilize the high adaptivity of the maxillary structures in young patients

The ideal treatment timing for diabetic retinopathy: the molecular pathological mechanisms underlying early-stage diabetic retinopathy are a matter of concern

Diabetic retinopathy (DR) is a prevalent complication of diabetes, significantly impacting patients’ quality of life due to vision loss. No pharmacological therapies are currently approved for DR, excepted the drugs to treat diabetic macular edema such as the anti-VEGF agents or steroids administered by intraocular route. Advancements in research have highlighted the crucial role of early intervention in DR for halting or delaying disease progression. This holds immense significance in enhancing patients’ quality of life and alleviating the societal burden associated with medical care costs. The non-proliferative stage represents the early phase of DR. In comparison to the proliferative stage, pathological changes primarily manifest as microangiomas and hemorrhages, while at the cellular level, there is a loss of pericytes, neuronal cell death, and disruption of components and functionality within the retinal neuronal vascular unit encompassing pericytes and neurons. Both neurodegenerative and microvascular abnormalities manifest in the early stages of DR. Therefore, our focus lies on the non-proliferative stage of DR and we have initially summarized the mechanisms involved in its development, including pathways such as polyols, that revolve around the pathological changes occurring during this early stage. We also integrate cutting-edge mechanisms, including leukocyte adhesion, neutrophil extracellular traps, multiple RNA regulation, microorganisms, cell death (ferroptosis and pyroptosis), and other related mechanisms. The current status of drug therapy for early-stage DR is also discussed to provide insights for the development of pharmaceutical interventions targeting the early treatment of DR

Aetiology and management of class III malocclusion

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas MonizClass III malocclusion is characterized by a complex three-dimensional facial skeletal disparity between maxillary and mandibular growth patterns along with varying degrees of dentoalveolar and soft tissue compensations. In terms of severity, this malocclusion ranges from dentoalveolar abnormalities or functional anterior mandibular displacement to true skeletal problems with substantial maxillomandibular discrepancies. In addition, this condition can be aggravated by vertical growth problems. Skeletal Class III malocclusions can be a result of retrognathic maxilla with a normal mandible both in position and in size, or prognathic mandible with a normal maxilla both in position and in size or a combination of retrognathic maxilla with prognathic mandible. Although not very prevalent, skeletal Class III malocclusion represents a huge challenge in terms of therapeutic approach and post-treatment stability. Hence, to determine a realistic and appropriate management and the ideal treatment timing, it is essential to establish an accurate diagnosis. Moreover, a thorough understanding of craniofacial growth and development is required to estimate the remaining growth, especially when growth modification is envisioned. The aim of this literature review was to provide an overview of Class III malocclusion, with emphasis on its aetiology and components. Evidence based approach and critical appraisal of the relevant literature in English and Portuguese languages between the years 1899 – 2021 were performed. Several search engines were employed such as Pubmed, google scholar Scielo, B-on, the Cochrane data base and relevant books on the subject. The following keywords were used throughout the research process: Class III malocclusion, aetiology, treatment, mandibular prognathism.A maloclusão de Classe III caracteriza-se por uma complexa disparidade esquelética facial tridimensional entre o padrão de crescimento maxilar e mandibular, apresentando diferentes graus de compensações dentoalveolares e de tecidos moles. Em termos de gravidade, esta maloclusão varia desde anormalidades dentoalveolares ou deslocamento mandibular anterior funcional a verdadeiros problemas esqueléticos com discrepâncias maxilomandibulares substanciais. Além disso, esta condição pode ser agravada por problemas verticais de crescimento. As maloclusões de Classe III esquelética podem ser resultado de uma maxila retrognata com uma mandíbula normal, tanto em posição como em tamanho, ou mandíbula prognata com uma maxila normal tanto em posição como em tamanho ou numa combinação de ambas. Embora não muito prevalente, a maloclusão de Classe III esquelética representa um enorme desafio em termos de abordagem terapêutica e estabilidade pós-tratamento. Assim, para determinar uma terapia realista e adequada e o timing ideal para o tratamento, é essencial estabelecer um diagnóstico preciso. Além disso, é necessária uma compreensão aprofundada do crescimento e desenvolvimento craniofacial para estimar o crescimento remanescente, especialmente quando se pretende uma intervenção esquelética. Esta dissertação tem como objetivo proporcionar uma visão geral da maloclusão de Classe III, com ênfase na sua etiologia e características. Foram realizadas abordagens baseadas em evidências e avaliação crítica da literatura relevante em língua Inglesa e Portuguesa entre os anos 1899 - 2021. Várias plataformas de busca foram utilizadas, como Pubmed, o académico do Google Scielo, B-on, Cochrane e livros relevantes sobre o assunto. As seguintes palavras-chave foram usadas durante todo o processo de investigação: maloclusão classe III, etiologia, tratamento, prognatismo mandibular

The STOP COVID 2 study: Fluvoxamine vs placebo for outpatients with symptomatic COVID-19, a fully remote randomized controlled trial

BACKGROUND: Prior randomized clinical trials have reported benefit of fluvoxamine ≥200 mg/d vs placebo for patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS: This randomized, double-blind, placebo-controlled, fully remote multisite clinical trial evaluated whether fluvoxamine prevents clinical deterioration in higher-risk outpatients with acute coronavirus disease 2019 (COVID-19). Between December 2020 and May 2021, nonhospitalized US and Canadian participants with confirmed symptomatic infection received fluvoxamine (50 mg on day 1, 100 mg twice daily thereafter) or placebo for 15 days. The primary modified intent-to-treat (mITT) population included participants who started the intervention within 7 days of symptom onset with a baseline oxygen saturation ≥92%. The primary outcome was clinical deterioration within 15 days of randomization, defined as having both (1) shortness of breath (severity ≥4 on a 0-10 scale or requiring hospitalization) RESULTS: A total of 547 participants were randomized and met mITT criteria (n = 272 fluvoxamine, n = 275 placebo). The Data Safety Monitoring Board recommended stopping early for futility related to lower-than-predicted event rates and declining accrual concurrent with vaccine availability in the United States and Canada. Clinical deterioration occurred in 13 (4.8%) participants in the fluvoxamine group and 15 (5.5%) participants in the placebo group (absolute difference at day 15, 0.68%; 95% CI, -3.0% to 4.4%; log-rank CONCLUSIONS: This trial did not find fluvoxamine efficacious in preventing clinical deterioration in unvaccinated outpatients with symptomatic COVID-19. It was stopped early and underpowered due to low primary outcome rates. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov Identifier: NCT04668950

Cervical Vertebral Maturation Stage as a Growth Predictor

I would like to express my sincere appreciation to the members of my thesis committee: Dr Stuart Hunter, Dr Antonios Mamandras, Dr Lesley Short, Dr David Banting, Dr John Murray and Dr Brian Tompson. In particular, thank you to my thesis supervisor, Dr Stuart Hunter, for your help and support during my thesis project. You are an inspiration and a role model to me. A special thank to Dr Antonios Mamandras and to Dr Lesley Short for their help and support through the whole program. You made my experience at Western unforgettable. For all the support provided to me in completing this thesis and this program, thank you Barb Merner, Joanne Pfaff, Leesa Couper, Evelyn Larios, PJ Blake, Justina Hovarth, Jackie Geneau and Cynthia Mugimba. You made my experience at Western memorable. I want to say thanks to all of my co-residents: Nadia, Mitch, Dolly, Ali, Mark, Mike, Mariela, Manisha, Neville, Dana, Phil and Julia. Thank you for your comradery, support and humour. To my classmates Ziad and Julia, the past three years have been a true learning experience. Thank you for being such good classmates. I will never forget all the special moments we shared together. Most importantly, I dedicate this thesis to my entire family. To my husband Jalal, thank you for your love, patience and support. Thank you for believing in me and for supporting me in every step of the way. I couldn’t have done it without you. To Mom and Dad, thank you for believing in me every day of my life. Your love and support over the last three years allowed me to follow my dream. I am eternally grateful. To my adorable daughter Mayali, I know we will be able to make up for lost time together but know you are my raison d’être and the sunshine in my life

Orthodontists’ preferences in the use and timing of appliances for the correction of malocclusions in growing patients

Objective: To evaluate orthodontists’ preferences in the use and timing of appliances for the correction of Class II and Class III malocclusions in growing patients and the sociodemographic factors that influence these preferences. Material and Methods: Active members of the Colombian Orthodontics Society (SCO) were invited to complete a previously validated survey on the use of Class II and Class III correctors in growing patients. Results: 180 orthodontists responded (80 male, 100 female). The appliances used most frequently in the treatment of Class II malocclusion were Planas indirect tracks (32.78%) and Twin-blocks (30.56%). Facemasks (62.22%) and Progenie plates (25%) were the most prevalent appliances used in the treatment of Class III malocclusions. Regarding treatment timing, 52% of the orthodontists stated that Class II malocclusions must be treated during late mixed dentition or early permanent dentition, 42% stated that treatment for Class III malocclusions sho-uld occur during early mixed dentition. Appliance use and treatment timing were significantly associated with sex (p= 0.034), years of practice (p= 0.025), and area of work (private clinics or public institutions), (p= 0.039). Conclusion: Twin-blocks and Facemask appliances were the preferred appliances for Class II and Class III treatment, respectively, in growing patients. Most of the orthodontists believed that Class II malocclusions must be treated during late mixed dentition and that Class III malocclusions must be treated during early mixed dentition. Sociodemographic variables are related factors that influence orthodontists’ preferences in the use of these appliances