Dental fractures: types, causes, and treatment

Studies indicate that the management of dental fractures might be challenging because many cases present with minor, hard-to-discover traumas, requiring extensive evaluation and diagnostic procedures. Accordingly, adequate management can only be achieved by establishing a proper diagnosis, drawing an adequate treatment plan, and conducting regular follow-up appointments. We have discussed the different causes, types, and treatments of dental fractures. The commonest causes include impaction by trauma, whether direct or indirect. Many traumatic events were reported in the literature, and age and carious lesions are important factors to consider. Many types of dental fractures were also reported in the literature, including root fractures, crown root fractures, enamel-dentin fractures with and without pulp exposure or crown fractures, enamel infractions, and fractures. Other types include avulsion, intrusion, extrusion, lateral luxation, concussion or subluxation, splinting, and alveolar segment fractures. The treatment should be integrated based on the fracture type, and adequate follow-up should be established to achieve the best predictive outcomes.

ESTUDO ECOLÓGICO: PERFIL DA MORBIMORTALIDADE POR HANSENÍASE NO BRASIL ENTRE 2015 E 2019

Leprosy is a chronic, infectious disease transmitted through the inhalation of aerosols containing Mycobacterium leprae. The present study was carried out to investigate the epidemiological profile of leprosy in Brazil between 2015 and 2019, evaluating the prevalence rate of hospital admissions, incidence rate, number of admissions due to recurrence and mortality rates. It is an ecological study conducted from data collected in information systems available at the Departamento de Informática do Sistema Único de Saúde (DATASUS). In the considered time interval, a slight improvement in the investigated health indicators was evidenced. It is possible to infer that the country carried out an adequate management of leprosy between 2015 and 2019, probably because of good prophylactic actions, good interventions and efficient awareness of those infected.

Total Oral Rehabilitation with Dental Implants in an Elderly Patient with Concomitant Diseases: a Case Report

We report a case of restoration of the masticatory and phonetic functions of a senior patient with comorbidities who receives systemic medication and lacks sufficient bone volume for implant placement in the accurate position. X-ray shows severe asymmetric atrophy of the mandible, especially on the right sight, which affects the location of the mandibular canal. This greatly limits and complicates the restoration of the masticatory and phonetic functions with conventional prostheses. Adequate management of medication and long-term disease control of the patient allow safe surgery for tooth extraction and placement of intraosseous implants in the jaw bones.

IgE multiple myeloma: detection and follow-up

Objectives We report a new case of immunoglobulin E multiple myeloma (IgE), a very rare isotype that accounts for <0.1% of cases of this monoclonal gammopathy. To ensure the adequate detection, quantification and identification of the monoclonal component, it is crucial that protein assays are performed. We provide some clues related to clinical laboratory results, which will facilitate an adequate management of the disease. Case presentation A 45-year-old patient with a five-week history of pain at the level of the elbow, who was diagnosed with IgE-Kappa multiple myeloma based on laboratory, radiological, and bone marrow findings. The patient received induction chemotherapy prior to hematopoietic stem-cell transplantation and is currently on follow-up. Conclusions Protein assays performed in the clinical laboratory, including protein electrophoresis and immunofixation, allowed for the detection of an IgE-Kappa monoclonal component prior to the appearance of the typical CRAB symptoms (hypercalcemia, renal involvement, anemia, and bone pain) of multiple myeloma (MM). The detection of IgE-Kappa facilitated early diagnosis and management.

How to Improve the Performance of Micro, Small, and Medium Enterprises?

Objective - The COVID-19 pandemic has worsened economic conditions and jeopardized the performance of many micro, small and medium enterprises (MSMEs) in Indonesia. So the question arises of how to improve its performance so that MSMEs can maintain their survival in conditions like this. This study aims to answer these problems, namely to analyze the influence of management characteristics on MSME business performance with innovation as a mediator. The population in this study is MSMEs from various types of businesses in Indonesia. Methodology/Technique - A total of 123 samples were selected by stratified judgment sampling. Data were collected through self-administered questionnaires. Finding - Data analysis using structural equation model (SEM) partial least squares (PLS) program. Novelty - Based on the analysis conducted, it can be concluded that to improve the performance of MSMEs, management characteristics need to be strengthened by efforts to create innovation, because without strengthening innovation, only having adequate management characteristics will not increase MSME performance. Type of Paper - Empirical Keywords: Characteristics; Innovation; Micro small and medium enterprises (MSMEs); Performance JEL Classification: M19

Circumstances of occurrence of uterine ruptures treated in a national reference maternity department in Benin from 2015 to 2019

Background: Uterine rupture is an obstetric disaster and a major concern for the obstetrician in an African environment because of the insufficient technical support. Objective of current study was to study the circumstances of occurrence of uterine ruptures.Methods: The study was carried out at the university clinic of obstetrics and gynecology of CNHU-HKM in Cotonou. This was a descriptive and cross-sectional study with retrospective collection from January 1, 2015 to December 31, 2019. We made an exhaustive recruitment of all the patients treated in the department for uterine rupture during the study period. The study variables were socio-demographic and clinical characteristics. Data confidentiality and the anonymity of women were respected.Results: The study involved 85 cases of uterine rupture. Patients were relatively young with a mean age of 30±15.02 years. Women profile was that of populations with unfavorable socio-economic conditions. The circumstances of discovery were multiparity equal to or greater than 4 (43.5%), scarred uterus (32.9%), non-use of partogram (97.6%), osseous dystocia (10.9%) and fetal dystocia with fetal macrosomia (21.2%) and dystocic presentation (15.3%).Conclusions: This study identified epidemiological and clinical characteristics related to the circumstances of known uterine ruptures occurrence. A preventive and anticipatory oriented approach can reduce the frequency of that obstetric tragedy, the adequate management of which is often uncertain in Benin.

Modeling the Integral Indicator of the Enterprise Economic Security Management

The article considers the current aspects of the enterprise economic security, analyzes the features of its assessment and substantiates the expediency of using an integral indicator of the economic security management of the enterprise. Based on the use of factor analysis and the method of chain substitutions, an adaptive assessment system was built, which is highly sensitive to rapid changes in the external environment and the characteristics of the enterprise’s functioning. This approach makes it possible to develop adequate management measures to identify risks, determine the causes of their occurrence and measures to prevent risks or eliminate their negative impact. That is, the result of the implementation of such a methodology should be information that will allow management to make adequate management decisions in a timely manner, develop and implement effective measures to ensure the economic security of the enterprise in counteracting internal and external risks.

Assessment of asbestos and asbestos waste quantity in the built environment of transition country

Managing asbestos streams in developing and transition countries is particularly challenging. Deficiencies are often present for adequate procedures for the management of asbestos waste; solid quality data or databases on the quantities of asbestos production and usage are missing and asbestos inventories or the registry of asbestos-related diseases following European Union (EU) or other regulations are not in place. This paper aims to develop a model for determining and assessing the quantity of asbestos in the built environment of a transition country. Quantities of asbestos products and life expectancy of those products were assessed to develop a model that forecasts flows and stocks of asbestos products and wastes. The overall objective is to evaluate the model and show the manifestation of asbestos in the waste stream in a case study on a country with a transition economy, such as Serbia. Results show that total quantities of asbestos fibre consumption are approximately 0.5 million tonnes; the largest amount of waste generation is expected in the 2020s. Therefore, it is necessary to prepare for the forthcoming quantities of waste by improving legal procedures, implementation of existing regulations, and provision of economic resources. An important link for the adequate management of asbestos waste is to raise public awareness of the dangers and importance of proper and timely disposal of asbestos products.

The pain in the Emergency Department: Choosing and treating wisely before and during the COVID-19 era

Pain is a frequent reason for referral to the Emergency Department (ED). Adequate management of pain is a moral and ethical imperative. If not correctly treated, acute pain can cause physical and psychological complications, and become chronic with severe consequences such as anxiety, depression, and social isolation. As consequence, emergency clinicians should treat pain as soon as possible, avoiding delays even in case of acute abdominal pain. Pain management is particularly complex in the elderly and emergency clinicians should always consider AGS Beers criteria ® to avoid inappropriate medications, severe side-effects, and drug-drug interactions. Pain is also a common cause of delirium in older patients. The SARS CoV-2 infection not only can cause acute pain, but also exacerbate chronic pain, particularly in the elderly, who are at high risk to be infected. Looking at all this evidence, emergency clinicians should treat pain with different strategies according to their experience and cultural background, making the right choice for each patient. This work is a critical review of the pain management in the ED, with a particular attention on the effects of COVID-19 in the EDs. We conducted a systematic search of the following databases: PubMed, Google Scholar, Science Direct, Medline from 2000 to 2020, using the keywords of “pain”, “emergency”, “COVID19”, “elderly”, “palliative care”, “ketamine”, “dexmedetomidine”, and “post-traumatic stress disorder”. The aim of this review is to help emergency clinicians to correctly manage pain in the ED with a new point of view regarding the pain management in COVID-19 patients.

Serum Cytokeratin 18 as a Metastatic and Therapeutic Marker for Extramammary Paget’s Disease

Extramammary Paget’s disease (EMPD) is a rare cutaneous adenocarcinoma with unfavorable prognosis once it becomes invasive. A tumor marker that reflects disease progression is required for adequate management of this disease. Cytokeratin 18 is highly expressed in many types of cancer and its soluble forms are detected by M30 (for caspase-cleaved form) and M65 (for both caspase-cleaved and intact forms) assays. Here, we report that tumor cells of EMPD in both lesional skin and lymph node metastasis are positive for CK18 immunohistochemically and the baseline serum M30 and M65 levels in metastatic EMPD patients are significantly higher than those in non-metastatic patients. In addition, serial serum M30 and M65 levels might reflect recurrence of EMPD and response to chemotherapy. These results suggest that serum CK18 levels may be a useful tumor marker for advanced EMPD.