Factors Involved in the Perception of Enamel Dyschromic Lesions—A Questionnaire-Based Study

Dyschromic lesions (DLs) of tooth enamel are common disorders, with multiple etiologies and various clinical forms, that raise public health concerns. This study aimed to determine the factors that influence the perception of DLs and to assess the perceived need for dental treatment in various clinical cases. A paper-based questionnaire with attached images of frontal teeth exhibiting different DLs was distributed to patients, dental students, and dentists. A total of 383 volunteers participated in this study, and their answers were statistically described and analyzed. This study found that in cases with multiple, well-demarcated areas of opacities associated with diffuse opacities on neighboring teeth, most respondents noticed and reported only the most severe lesions, disregarding the minor ones. The contrast of the lesion with the color of the substrate influenced the overall perception and a significant correlation between these two variables was found. However, the color of the DLs did not significantly impact the overall perception of the lesions. A higher overall perception of DLs was significantly correlated with a favorable opinion regarding the need for treatment. Furthermore, gender and medical background were significantly associated with the overall perception of DLs.

Recent advancement in the treatment of boys and adolescents with hypogonadism

Clinical manifestations and the need for treatment varies according to age in males with hypogonadism. Early foetal-onset hypogonadism results in disorders of sex development (DSD) presenting with undervirilised genitalia whereas hypogonadism established later in foetal life presents with micropenis, cryptorchidism and/or micro-orchidism. After the period of neonatal activation of the gonadal axis has waned, the diagnosis of hypogonadism is challenging because androgen deficiency is not apparent until the age of puberty. Then, the differential diagnosis between constitutional delay of puberty and central hypogonadism may be difficult. During infancy and childhood, treatment is usually sought because of micropenis and/or cryptorchidism, whereas lack of pubertal development and relative short stature are the main complaints in teenagers. Testosterone therapy has been the standard, although off-label, in the vast majority of cases. However, more recently alternative therapies have been tested: aromatase inhibitors to induce the hypothalamic-pituitary-testicular axis in boys with constitutional delay of puberty and replacement with GnRH or gonadotrophins in those with central hypogonadism. Furthermore, follicle-stimulating hormone (FSH) priming prior to hCG or luteinizing hormone (LH) treatment seems effective to induce an enhanced testicular enlargement. Although the rationale for gonadotrophin or GnRH treatment is based on mimicking normal physiology, long-term results are still needed to assess their impact on adult fertility.

A combination of potently neutralizing monoclonal antibodies isolated from an Indian convalescent donor protects against the SARS-CoV-2 delta variant

Although efficacious vaccines have significantly reduced the morbidity and mortality due to COVID-19, there remains an unmet medical need for treatment options, which monoclonal antibodies (mAbs) can potentially fill. This unmet need is exacerbated by the emergence and spread of SARS-CoV-2 variants of concern (VOCs) that have shown some resistance to vaccine responses. Here we report the isolation of two highly potently neutralizing mAbs (THSC20.HVTR04 and THSC20.HVTR26) from an Indian convalescent donor, that neutralize SARS-CoV-2 VOCs at picomolar concentrations including the delta variant (B.1.617.2). These two mAbs target non-overlapping epitopes on the receptor-binding domain (RBD) of the spike protein thereby preventing the virus attachment to its host receptor, human angiotensin converting enzyme-2 (hACE2). Furthermore, the mAb cocktail demonstrated protection against the Delta variant at low antibody doses when passively administered in the K18 hACE2 transgenic mice model, highlighting their potential as cocktail for prophylactic and therapeutic applications. Developing the capacity to rapidly discover and develop mAbs effective against highly transmissible pathogens like coronaviruses at a local level, especially in a low- and middle-income country (LMIC) such as India, will enable prompt responses to future pandemics as an important component of global pandemic preparedness.

A mixed methods study examining perceptions by service-users of their involuntary admission in relation to levels of insight

Background: Poor insight is associated with negative attitudes to involuntary admission and care in qualitative studies. Aims: The current paper aims to examine and compare retrospective qualitative perceptions of service-users in relation to their involuntary admission with their levels of clinical insight, using a mixed methods approach. Methods: Forty two participants were assessed 3 months after the revocation of their involuntary admission. Each provided qualitative data relating to their perceptions of the coercive care process, which was analysed using content analysis, along with a quantitative measurement of insight, the Schedule for the Assessment of Insight-Expanded (SAI-E). Employing a mixed methods design and incorporating NVivo matrix coding queries, the datasets were merged to enable qualitative themes to be identified against the quantitative data. Results: Differences were observed between those with high and low insight in terms of their understanding of the need for treatment, their levels of arousal at the time of admission and how they perceived the compassion of health professionals. Certain negative perceptions of care appeared more universal and were common across those with high and low insight. Conclusion: Some negative perceptions of coercive practices appear linked to inherent elements of psychotic illness such as unawareness of illness. Individuals with higher levels of insight tended to perceive their involuntary admission and receiving a diagnosis as beneficial. Negative views that persist amongst service users with high insight levels can highlight areas for successful service improvement, including increased emphasis on non-pharmacotherapy based supports during the coercive care process.

Recent Advances in Anticoagulant Treatment of Immune Thrombosis: A Focus on Direct Oral Anticoagulants in Heparin-Induced Thrombocytopenia and Anti-Phospholipid Syndrome

For more than 10 years, direct oral anticoagulants (DOACs) have been increasingly prescribed for the prevention and treatment of thrombotic events. However, their use in immunothrombotic disorders, namely heparin-induced thrombocytopenia (HIT) and antiphospholipid syndrome (APS), is still under investigation. The prothrombotic state resulting from the autoimmune mechanism, multicellular activation, and platelet count decrease, constitutes similarities between HIT and APS. Moreover, they both share the complexity of the biological diagnosis. Current treatment of HIT firstly relies on parenteral non-heparin therapies, but DOACs have been included in American and French guidelines for a few years, providing the advantage of limiting the need for treatment monitoring. In APS, vitamin K antagonists are conversely the main treatment (+/- anti-platelet agents), and the use of DOACs is either subject to precautionary recommendations or is not recommended in severe APS. While some randomized controlled trials have been conducted regarding the use of DOACs in APS, only retrospective studies have examined HIT. In addition, vaccine-induced immune thrombotic thrombocytopenia (VITT) is now a part of immunothrombotic disorders, and guidelines have been created concerning an anticoagulant strategy in this case. This literature review aims to summarize available data on HIT, APS, and VITT treatments and define the use of DOACs in therapeutic strategies.

Comparison of the Occlusal Feature Index (OFI) and Dental Aesthetic Index (DAI) in 10–14-year-old children at the Universitas Sumatera Utara Dental Hospital

Background: Malocclusion often occurs in children due to discrepancies between primary teeth and permanent teeth. An assessment of the severity of the malocclusion is necessary for establishing the diagnosis and determining the need for treatment. The Occlusal Feature Index (OFI) and Dental Aesthetic Index (DAI) are indices that assess the need for orthodontic treatment, but they use different weights. Purpose: This study aimed to compare the need for orthodontic treatment based on the OFI and DAI in 10–14-year-old children. Methods: The sample in this study is secondary data in the form of 66 study models pre-treatment in children aged 10–14 years at the Universitas Sumatra Utara (USU) Dental Hospital. All samples were collected based on inclusion and exclusion criteria. The measurement results were analysed statistically by the Chi-square test to see the comparison between the OFI and DAI. The results obtained are presented in the form of frequency and percentage. Results: For the OFI, 42.4% of the samples had no orthodontic treatment needed, 31.8% were indicated to treat, and 25.8% require mandatory treatment. For the DAI, 47% of samples had no/little treatment need, 25.8% had elective treatment need, 16.7% had treatment considered mandatory, and 10.6% treatment highly desirable. Based on the assessment to compare the OFI and DAI using the Chi-square test, p=0.001 was obtained. Conclusion: There was a significant difference in the need for orthodontic treatment between OFI and DAI in children aged 10–14 years at the USU Dental Hospital.

A Cross-Sectional Evaluation of Self-Perceived Orthodontic Treatment Needs Amongst Tribal Adolescent With Remote Access to Orthodontic Treatment Using a Simplified Malocclusion Index

Background: Self-perceived orthodontic treatment need is strongly influenced by what is perceived to be the esthetic norm amongst a community, and reluctance toward treatment amongst adolescents with clinically ascertained malocclusion may often be due to readily remediable factors. Of particular interest is the prevalence of malocclusion amongst such communities as a probable indicator of the role of diet and genetics in establishing a predominant clinical phenotype that may also play a role in the construct of what is perceived as the esthetic norm amongst the community, thereby influencing the self-perceived need for treatment. Studies aimed at evaluating the association between self-perceived esthetics, and self-perceived treatment need have not been performed amongst a population with no prior exposure to orthodontic treatment Objectives: The purpose of this study was to evaluate the self-perceived orthodontic treatment need amongst the tribal adolescents belonging to regions with remote access to orthodontic treatment by way of a verbally assigned index and to also identify the reasons of reluctance toward treatment to better understand how to make orthodontic treatment readily accessible to such populations. Participants, Materials, and Methods: The agency areas of Paderu located at 18.0833°N 82.667°E and Parvathipuram located at 18°46'N 83°25'E are 2 revenue districts of Visakhapatnam and Vizianagaram, respectively, in the state of Andhra Pradesh, India, that are home to various tribal populations with remote access to orthodontic treatment. A total of 2,016 school-going tribal adolescents of the Paderu revenue division and 819 tribal adolescents of the Parvathipuram revenue division were examined to ascertain the prevalence of malocclusion. Necessary consent and permissions were obtained from the tribal authorities, the school authorities, parents, and the institutional ethical clearance committee. The screening was done utilizing natural daylight in compliance with infection prevention and control protocol. Clinical examination aimed at categorizing the observed occlusion into either ideal occlusion or one of the three classes of Angle’s class I, II, and III malocclusions. The Simplified Malocclusion Index For Layperson Evaluation (SMILE) was verbally assigned in the vernacular language while interacting with each child and the findings made note of for calculation of relevant scores related to their orthodontic awareness, self-esteem as related to self-perceived esthetics, and their self-perceived need for treatment. Reasons for reluctance to undergo treatment were noted down if expressed. An initial group of 31 adolescents categorized as presenting with clinical malocclusion were randomly picked up and assigned the SMILE index a second time to assess the reliability of the index by way of Cohen’s kappa statistic. Results: The initial test group of 31 individuals assigned the SMILE twice showed a Cohen’s kappa of 0.93 validating almost perfect intraoperator agreement. The SMILE index revealed that 80.95% of the adolescents of Paderu revenue division had orthodontic awareness and 79.51% had self-perceived esthetics but only 15.97% felt a need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 1,371] = 19.71, P < .001). The Index assigned to the Parvathipuram division revealed that 77.04% had orthodontic awareness and 78.38 had self-perceived esthetics but only 6.95% felt the need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 764] = 4.95, P = .02). Conclusion: The self-perceived need for orthodontic treatment is often based on the self-perceived esthetics of an individual or the self-esteem as influenced by the perceived esthetic norm of the community. Orthodontic treatment of adolescents with borderline malocclusion derangements requires careful ascertaining of the actual perceived need of the patient to enable the rendering of a justifiable orthodontic treatment with the complete trust of the young patient. This helps build community trust in regions where orthodontic treatment has not yet made in roads and may help ensure higher end of treatment satisfaction levels.

The Effect of Education on Anxiety and Social Adjustment of Parents with Children with Corona Referred to Ali Asghar Hospital

Covid19 may cause experiences of psychological disorders such as anxiety and depression, stress in families and children. The psychological impact of the coronavirus in all patients should be considered in addition to physical symptoms. Method: In the training intervention group, 4*45 min sessions per week, was conducted by telephone and online. Items such as how the disease occurs, the factors that cause its symptoms and complications, treatment of the disease, the need for treatment of the disease, lifestyle changes, the need for preventive activities such as masking, use of alcohol spray, quarantine, avoid touching contaminated surfaces and avoid losing with friends and relatives and follow proper nutrition tips, advise to calm and stress caused by corona, should be receptive and listened and managed. Support the child. Provide a suitable environment during quarantine. Ask for help from support centers if needed. Have a flexible but regular daily schedule to teach your child to keep a safe distance. Have family coordination at home. Results: According to the obtained results, we found that the distribution of Beck anxiety scores in the pre-examination, post- examination and follow-up stages is normal and the p- value is greater than 0.05 (p 0.00.05). It can be concluded that corona education to parents has been significantly effective in reducing their mean anxiety. scores in the post-examination stage is greater than the significance level (p 0.0 0.05). Therefore, it can be concluded that the difference between the mean adjustment scores at different times is different according to the studied variables. Conclusion: The results of the present research demonstrated that after training anxiety and adjustment in the two groups, information support of patients' families will help them to better adapt in the face of stressful situations. Thus, educating the patients and their family increases the level of information and reduces the anxiety of the patient and the family and reduces the problems facing of the disease. Although families experience high stressors from the corona, but providing the necessary training for parents and increase supports may be necessary to be successful.

P-OGC96 Oesophagectomy with Enhanced Recovery for Adenocarcinoma in the Elderly

Background The incidence of oesophageal adenocarcinoma is rising rapidly in high-income countries. Combined with an ageing population, it is expected that the need for treatment, including surgery, will increase in the next decade. Oesophagectomy in patients ≥70 years old has been associated with a higher risk of complications. The aim of our study is to compare the outcomes of patients ≥70 vs &lt; 70 years old, who underwent oesophagectomy for adenocarcinoma with an enhanced recovery (ERAS) protocol. Methods A single-centre retrospective study was performed. Eligible cases were divided into the &lt;70 and the ≥70 groups for comparison of baseline variables, postoperative outcomes, and overall survival. Results From January 2014 through September 2020, oesophagectomy with ERAS was performed for 230 patients with adenocarcinoma. Most (85%) patients were male. The median age was 70 years. The overall 90-day complication rate was 69.6%. The anastomotic leak rate was 16.1%. The 30- and 90-day mortality rates were 0 and 3.0% respectively. Median length of stay (LoS) was 7.0 days (IQR=5.0) and the readmission rate was 18.7%. The overall complication rate was higher in the ≥70 vs the &lt;70 group (75.6% vs 63.1%; p = 0.038). There was no significant difference in major complications, anastomotic leakage, mortality, LoS, or readmission (p &gt; 0.05) between the groups. Estimated mean survival was lower in the ≥70 vs the &lt;70 group (45.6 vs 57.9 months; p = 0.045). Conclusions Elderly patients with oesophageal adenocarcinoma can undergo oesophagectomy with ERAS, achieving similar postoperative outcomes to younger patients. In an era of an ageing population with an increasing disease burden, these findings are encouraging.