Utku Böcüoğlu, Esra Ateş Yıldırım, Selma Erdoğan Düzcü
et al.
Abstract Objectives This in vitro study aimed to evaluate the effect of laser photobiomodulation on the structural integrity and degradation resistance of two types of platelet-rich fibrin membranes: Leukocyte- and Platelet-Rich Fibrin (L-PRF) and Titanium-Prepared Platelet-Rich Fibrin (T-PRF). Structural changes in the fibrin network were assessed using Scanning Electron Microscopy (SEM) and light microscopy. Materials and methods Our study was performed on 15 systemically healthy individuals and four L-PRF and four T-PRF membranes obtained from each individual, totaling 120 samples. L-PRF was prepared first using standard vacuum glass tubes. Two weeks later, new blood samples were collected from the same individuals, and T-PRF membranes were prepared using sterile titanium tubes to enhance biocompatibility. Both membrane types were obtained by centrifugation at 2700 revolutions per minute (rpm) for 12 min. Two of the four membranes were treated with a diode laser device at a wavelength of 980 nanometers (nm) and a power of 0.5 W (W) in continuous mode for 3 min at a distance of 1–2 milimeters (mm). The other two membranes were not lasered. One of the laser treated L-PRF and T-PRF membranes was cut in half and stored under appropriate conditions for histological examination and SEM analysis. The other membrane was separated for degradation. The same procedures were performed for L-PRF and T-PRF membranes without laser treatment. Result Laser-treated L-PRF and T-PRF membranes showed lower degradation percentages compared to non-laser-treated membranes, but this difference did not reach statistical significance (p > 0.05). However, when laser treated L-PRF and T-PRF membranes were compared, the degradation percentage was significantly higher in L-PRF membrane (p < 0.05). Histologic examination showed that the fibrin network structure of the laser-applied L-PRF and T-PRF membrane groups was significantly denser than the non-laser-applied groups (p < 0.05). SEM analysis revealed that the fibrin network was denser, thicker and more complex in the laser-applied L-PRF and T-PRF membrane groups. Conclusion In this study, the biostimulative effect of laser increased the fibrin network thickness, cross-link structure and density of L-PRF and T-PRF membranes. When the degradation percentages on the membranes were evaluated, no significant difference was observed between the groups. Clinical relevance Understanding how laser photobiomodulation affects the structure and degradation resistance of both L-PRF and T-PRF membranes can guide clinicians in selecting the most suitable autologous biomaterial for enhancing wound healing and regenerative outcomes in dental procedures. The structure of PRF membranes used in dentistry can be improved using the biostimulative effect of the laser. This application may increase the use of these autologous and easily obtainable materials in treatments.
Aqilah Syafiqah Zamri, Aisyah Fathonah Md Nazir, Mohamad Shafiq Mohd Ibrahim
et al.
Aim: This research aims to evaluate the difference between what orthodontic patients expect and perceive regarding the quality of dental services at the Postgraduate Centre, Kulliyyah of Dentistry, International Islamic University Malaysia.Methods: A cross-sectional study was conducted involving 202 orthodontic patients selected through convenience sampling. A modified 20-item SERVQUAL questionnaire was used to measure patients’ expectations before treatment and their perceptions after receiving care. Data were collected during the same visit, and analysis was performed using SPSS version 28, applying Wilcoxon’s signed-rank test to evaluate differences between expectations and perception scores.P-value<0.05 considered as significant.Results: Significant differences were found between patients’ expectations and perceptions (P<0.05), except for “waiting time” (Q3), “visually appealing facilities” (Q4), “up-to-date equipment” (Q5), and “toilet cleanliness” (Q20). The highest satisfaction was reported for “neat appearance” (Q6), “politeness” (Q10), “caring attitude” (Q7) and “prompt treatment” (Q15). The smallest satisfaction gaps were observed for “toilet cleanliness” (Q20), “waiting time” (Q3), “up-to-date equipment” (Q5), “visually appealing facilities” (Q4), and “clear explanation of dental issues” (Q12). Overall, patients’ perceptions exceeded expectations across all dimensions, with positive gaps, though tangibles (D1) and assurance (D4) showed the least positive differences.Conclusion: The results indicated that orthodontic patients were generally satisfied with the quality of care received. Regular service evaluation and focused improvements, particularly in tangible and assurance aspects, are recommended to ensure high levels of patient satisfaction.
Background The purpose of this research was to compare the adhesive residual score/adhesive remnant index (ARI) and shear bond endurance between the two orthodontic bonding systems for zirconia surface bonding: Self-etch (Scotchbond Universal) and total-etch (Transbond XT). Materials and Methods Color-coded acrylic blocks embedded with zirconia slabs were prepared, and the orthodontic brackets (ceramic) were bonded using either the total-etch or self-etch system. Group 1, represented by pink-colored blocks ( N = 12), accommodated 12 zirconia surfaces using the total-etch system, while Group 2, represented purple-colored blocks ( N = 12), also housed zirconia surfaces using the self-etch system. The shear bond strength was evaluated using an Instron Universal Testing Machine, and ARI scoring was done upon debonding. The statistical software SPSS was used for the analyses. Results The average bonding strength for the Scotchbond Universal etch system was 6.21 ± 0.76 MPa, while for the total-etch system, it was 5.59 ± 1.37 MPa. The ARI scores revealed that 83% of surfaces bonded with the self-etch system had no adhesive residue (ARI score 0), compared to 66% for the total-etch system. Conclusion The self-etch bonding agent demonstrated superior bond strength (6.2 MPa) compared to the total-etch system (5.6 MPa). Furthermore, it exhibited better ARI scores, indicating minimal adhesive residue. These findings suggest that the self-etch system is preferable for bonding ceramic brackets to zirconia crowns, offering improved bonding efficacy and ease of clean-up.
Abstract Introduction There is a continued increase of older dependant adults in England. Foundation Dentists (FDs) are often the dental workforce being tasked with providing dental care to dependant older adults resident in care home settings. This study explores whether FDs have the experience and confidence to deliver this. Aim This service evaluation aimed to explore FDs’ attitudes, perceptions and experiences delivering dentistry to dependant older adults’ resident in care home settings; to help inform workforce and service delivery planning. Methods All North West England (NW) FDs were invited to complete a semi-structured questionnaire at a regional study session. Results were analysed using descriptive and thematic analysis. Results There were 93 (80.1%) respondents, with the majority aged 20–24 years old (56, 60.2%), female (57, 61.3%) and with an United Kingdom undergraduate dental degree (88, 94.6%). Most respondents had no experience in delivering care in a care home setting at either undergraduate (85, 91.4%) or FD level (84, 90.3%). Only 14 respondents (15.1%) reported confidence to deliver dentistry in a care home setting. Conclusion To deliver dental care for dependant older adults resident in care home settings, FDs require additional training and clinical support. There is a need to review the undergraduate dental curriculum and NHS postgraduate training programmes to increase knowledge and skills for this vulnerable group.
Dentistry is a branch of healthcare where nanobiotechnology is reverberating in multiple ways to produce beneficial outcomes. The purpose of this review is to bring into the awareness of the readers the various practical dimensions of the nano-dental complex (nanodentistry) in healthcare and how novelties linked with the field are revolutionizing dentistry. A methodological approach was adopted to collect the latest data on nanotechnology and dentistry from sources, including PubMed, Google Scholar, Scopus, and official websites like the WHO. Nanodentistry is an emerging field in dentistry that involves the use of nanomaterials, nanorobots, and nanotechnology to diagnose, treat, and prevent dental diseases. The results summarize the descriptive analyses of the uses of nanodentistry within orthodontics, preventive dentistry, prosthodontics, restorative dentistry, periodontics, dental surgeries, dental restoration technologies, and other areas of dentistry. The future directions of nano-industries and nano-healthcare have been included to link them with the oral healthcare sector, treatment plans, and improved medical services which could be explored in the future for advanced healthcare regulation. The major limitations to the use of dental nanoproducts are their cost-effectiveness and accessibility, especially in financially constrained countries. These data will help the readers to experience a detailed analysis and comprehensive covering of the diverse achievements of nanodentistry with past analyses, present scenarios, and future implications.
Mukesh Purohit, Abhay P. Kolte, Pranjali V. Bawankar
et al.
Purpose: The present study aimed to evaluate and compare the management of Jump space (JS) in immediate implants with and without Demineralised freeze-dried bone allograft (DFDBA) with flapless approach. Materials and Methods: The present study included 40 sites with immediate implant placement in the maxillary anterior region. Group 1 patients were treated without augmentation while Group 2 patients with DFDBA in the JS. Both the groups were further subdivided according to the horizontal dimensions as JS less (G1S1, G2S1) or more than 2mm (G1S2, G2S2). Plaque index (PI), Gingival Index (GI), Probing depth (PD), Testori esthetic score (TS), VAS score, Crestal Bone height (CBH), Ridge width (RW), Vertical distance (VD) and radiolucent area (RA) were evaluated radiographically with CBCT at baseline and 12 months’ post therapy. Results: Significant differences were observed in CBH in the midfacial region in G1S1- G2S1 with the mean of 0.34±0.19mm and G1S2 –G2S2 with 0.75±0.26 mm at 12 months. Significant differences in TS were observed in G1S1 and G2S1 with mean value of 0.55±0.53 while G1S2 and G2S2 exhibited value of 1.33±0.82. Conclusion: DFDBA shows better CBH preservation in midfacial region, reduction in RA indicating greater resolution of JS thereby leading to better hard and soft tissue healing.
Azadirachta indica commonly known as Neem, is an evergreen tree. Since time immemorial it has been used by Indian people for treatment of various diseases due to its medicinal properties. It possesses anti-bacterial, anti-cariogenic, anti-helminthic, anti-diabetic, anti-oxidant, astringent, anti-viral, cytotoxic, and anti-inflammatory activity. Nimbidin, Azadirachtin and nimbinin are active compounds present in Neem which are responsible for antibacterial activity. Neem bark is used as an active ingredient in a number of toothpastes and toothpowders. Neem bark has anti-bacterial properties, it is quite useful in dentistry for curing gingival problems and maintaining oral health in a natural way. Neem twigs are used as oral deodorant, toothache reliever and for cleaning of teeth. The objective of this article is to focus on the various aspects of Azadirachta indica in dentistry in order to provide a tool for future research.
Eman M. Mansory, Lotus Alphonsus, Janine R. Hutson
et al.
Background: Venous thromboembolism (VTE) remains one of the leading causes of morbidity and mortality during pregnancy and the postpartum period. Despite that, the prevention and management of VTEs in pregnant patients is an area of great debate. Objectives: The aim of this systematic review was to evaluate the risk of VTE recurrence during pregnancy for pregnant patients with prior personal history of VTE and the effect of LMWH on such risk. Methods: MEDLINE and EMBASE were searched between January 2000 to December 2022. We included studies that evaluated pregnant patients with previous personal history of VTE and assessed VTE recurrence with or without thromboprophylaxis. A meta-analysis of proportions was done through a Freeman–Tukey transformation using random effect models. Results: 30 studies were included in this systematic review. The studies included 5075 pregnant patients with a previous history of DVT or PE. We found a wide variability in thromboprophylaxis strategies. The estimated pooled proportions of VTE recurrence were 2.5% (95% CI 1.8–3.3) in patients who were consistently on anticoagulation during pregnancy (pre- and post-partum), 4.7% (95% CI 1.8–8.8) in patients who received anticoagulation in the postpartum period only, and 13.6% (95% CI 6.5 to 22.8) in patients who were not on anticoagulation. Conclusions: In patients with a previous VTE history receiving prophylactic anticoagulation (either both pre- and post-partum or post-partum only), the estimates of VTE recurrence were lower than for patients who did not receive prophylaxis, however, a direct comparison was not possible. The optimal thromboprophylaxis strategy remains unknown.
Diseases of the circulatory (Cardiovascular) system
Prof Muralidhar Mupparapu, Mr Anwar Radwan, Mr Muhammad Shammaa
et al.
Aim or Purpose: Our study seeks to classify the fusion of spheno-occipital synchondrosis (SOS) into 5 distinct novel stages based on CBCT visualization of SOS ossification. Materials and Methods: IRB-exempted protocol (#830154) was used to analyze CBCTs of 69 male and 67 female patients between the ages 5 and 25 using Osirix® and ITK SNAP® software. Midsagittal sections were sliced at 1mm to visualize the SOS. The mid-sagittal images were then organized based on gender and labeled according to the patient chronological age in years and months. These images were then classified using our novel 5-stage method. The 5 respective stages we developed are- SOS open (stage 1), the commencement of ossification (stage 2), less than 50% ossification at SOS (stage 3), greater than 50% ossification at SOS (stage 4), complete ossification of SOS (stage 5). Results: In our investigation thus far, it was noted that SOS ossification begins around 9.3 years in males and 8.7 years in females and is usually completely fused by the age of 17.8 for males and 14.9 for females. Conclusions: SOS is a cartilaginous cranial growth center that fuses the occipital and sphenoid bones during adolescence and can be used to assess the skeletal age of an orthodontic patient more accurately than existing methods without subjecting the patient to any additional radiation. Using the staging system proposed here, one can reliably and accurately determine the skeletal age of a patient. Our skeletal age estimation method may be used independently or as a supplement to hand-wrist radiographs and Cervical Vertebral Maturation.
Abstract Background A fixed screw-retained full-arch restoration supported by four implants is a popular treatment option for edentulous arches. Optimal alignment of implants is quite challenging in extremely atrophied edentulous cases, and a small amount of deviation is expected during guided surgery. This study aimed to compare implant accuracy among edentulous jaws with various levels of atrophy. Methods Five separate copies of each Cawood and Howell model (III–V) were produced for the maxilla and mandible. A total of 120 implants (30 models). The implant accuracy was assessed based on angular deviations at the base (angle, 3D offset, distal, vestibular, and apical) and tip (3D offset, distal, vestibular, and apical). Results The atrophy level of the jaws had a statistically significant effect on deviation; implants showed greater deviation from the planned location as the atrophy level increased. Conclusion Given that implant deviation increased with the degree of atrophy, a greater safety margin from important anatomical structures is recommended when planning implant location for guided surgery in Cawood and Howell V cases.
Diego Serrano-Velasco, Diego Serrano-Velasco, Andrea Martín-Vacas
et al.
PurposeThe aim of this systematic review is to evaluate the perception of the patient, the chairside time, and the reliability and/or reproducibility of intraoral scanners for full arch in pediatric patients.MethodsA data search was performed in four databases (Medline-Pubmed, Scopus, ProQuest and Web of Science) in accordance with the PRISMA 2020 statements. Studies were classified in three categories (patient perception, scanning or impression time and reliability and/or reproducibility). The resources, the data extraction and the quality assessment were carried out independently by two operators. The variables recorded were population characteristics, material and methods aspects and included country, study design and main conclusion. A quality assessment of the selected studies was performed with QUADAS-2 tool, and Kappa-Cohen Index was calculated to analyze examiner agreement.ResultsThe initial search obtained 681 publications, and finally four studies matching inclusion criteria were selected. The distribution of the studies in the categories was three for the analysis of the patient's perception and scanning or impression time; and two items to assess the reliability and/or reproducibility of intraoral scans. All included studies have a repeated measures–transversal design. The sample size ranged between 26 and 59 children with a mean age. The intraoral scanners evaluated were Lava C.O.S, Cerec Omnicam, TRIOS Classic, TRIOS 3-Cart and TRIOS Ortho. The quality assessment of the studies using QUADAS-2 tool revealed a low risk of bias while evaluating patient perception, but an unclear risk of bias in the analysis of accuracy or chairside time. In relation to the applicability concerns, the patient selection was of high risk of bias. All studies agreed that the patient perception and comfort is better with intraoral scanners in comparison with the conventional method. The accuracy or reliability of the digital procedure is not clear, being clinically acceptable. In relation with the chairside time, it depends on the intraoral scanner, with contradictory data in the different analyzed studies.ConclusionThe use of intraoral scanners in children is a favorable option, finding a significantly higher patient perception and comfort with intraoral scanners compared to the conventional impression method. The evidence for reliability or reproducibility is not strong to date, however, the differences between the intraoral measurements and the digital models would be clinically acceptable.
Z. Khurshid, Muhammad Sohail Zafar, S. Qasim
et al.
Rationalizing has become a new trend in the world of science and technology. Nanotechnology has ascended to become one of the most favorable technologies, and one which will change the application of materials in different fields. The quality of dental biomaterials has been improved by the emergence of nanotechnology. This technology manufactures materials with much better properties or by improving the properties of existing materials. The science of nanotechnology has become the most popular area of research, currently covering a broad range of applications in dentistry. This review describes the basic concept of nanomaterials, recent innovations in nanomaterials and their applications in restorative dentistry. Advances in nanotechnologies are paving the future of dentistry, and there are a plenty of hopes placed on nanomaterials in terms of improving the health care of dental patients.
Abstract Background The comparison of prostate-specific antigen (PSA) levels among older individuals with different periodontal statuses has not been fully investigated. Here we aimed to explore the correlation between the staging and grading of periodontitis and PSA levels in an elderly Chinese male population, which may lead to a biopsy recommendation and prevent prostate cancer as early as possible. Methods The study included 996 individuals aged ≥ 55 years who participated in routine postretirement physical examinations. Periodontal data included probing depth and gingival recession on four sites/tooth and on two diagonal quadrants (1–3 or 2–4) while excluding third molars, and clinical attachment loss was calculated. Periodontal status was classified as none, mild-moderate or severe periodontitis according to the Centers for Disease Control and Prevention and the American Academy of Periodontology case definition. Blood samples, oral health status and sociodemographic characteristics were collected by using general and oral examinations and questionnaires. Linear and logistic regressions were used to estimate the correlation between periodontitis severity and PSA levels, respectively. Results A total of 479 men had mild-moderate periodontitis and 355 had severe periodontitis; 162 men were periodontally healthy individuals. After adjusting for potential confounders, PSA levels were significantly lower in the individuals without periodontitis than in those with mild-moderate (P = 0.04) or severe (P = 0.03) periodontitis. However, PSA levels did not significantly correlate with periodontitis severity (P = 0.06). Although the ORs of elevated PSA were not significant, individuals with PSA ≥ 4.0 ng/mL were more likely to have periodontitis. Conclusions In a sample of an elderly Chinese male population, after adjusting for possible confounders, serum PSA levels in individuals with periodontitis were significantly higher than those in individuals without periodontitis, but serum PSA did not significantly correlate with periodontitis severity.
MARIA LAURA COSETTI OLIVERA, AMANDA RAMOS DA CUNHA, TAIANE SCHAEDLER PRASS
et al.
Introducción: Debido a su alta incidencia y elevada tasa de mortalidad, el cáncer de cabeza y cuello es considerado un problema de salud en muchos países. En Uruguay, en el periodo 2004- 2008 la tasa de mortalidad por cáncer oral y faríngeo fue 6,46 en hombres y 1, 16 en mujeres.
Objetivos: Analizar las tendencias de mortalidad por cáncer oral y orofaríngeo en Uruguay durante el período 1997-2014 y correlacionar con edad, sexo, sitio anatómico del tumor y distribución geográfica.
Materiales y métodos: Estudio ecológico de series temporales con datos secundarios. Los datos de mortalidad por cáncer oral y orofaríngeo fueron obtenidos en el Departamento de Estadísticas Vitales del Ministerio de Salud Pública de Uruguay y los datos sociodemográficos del Instituto de Estadísticas del Uruguay (año 2011). Fueron incluidas todas las neoplasias categorizadas de C00 a C10 en la 10a Revisión de la Clasificación Internacional de Enfermedades. Las tasas de mortalidad fueron estandarizadas x 100.000 habitantes, por sexo y por edad por el método directo, tomando con referencia la población uruguaya en el año 2011.
Resultados: Entre 1997 y 2014 hubo 1696 muertes por cáncer oral y orofaríngeo en Uruguay. La relación entre hombres y mujeres fue de 3.23:1 siendo la proporción más baja en neoplasias de glándulas salivales y la más alta en la región de orofaringe. Las tasas de mortalidad se han mantenido estables a lo largo de los años en cada sitio anatómico. La tasa de mortalidad en los hombres fue, en promedio, 4,70 veces mayor que en las mujeres, solo fue mayor para las mujeres en los
tumores de las glándulas salivales, excepto la parótida. En los diferentes grupos de edad, la tasa fue 4,84 veces mayor en hombres que en mujeres. Se observó la mortalidad está disminuyendo en los departamentos de Artigas y Rivera, manteniéndose estable en los demás departamentos.
Conclusión: La mortalidad por cáncer oral y orofaríngeo en Uruguay ha permanecido estable durante el período 1997-2014.
Antibiotic resistance has become an increasing challenge in the treatment of various infectious diseases, especially those associated with biofilm formation on biotic and abiotic materials. There is an urgent need for new treatment protocols that can also target biofilm-embedded bacteria. Many secondary metabolites of plants possess anti-bacterial activities, and especially the phytocannabinoids of the <i>Cannabis sativa</i> L. varieties have reached a renaissance and attracted much attention for their anti-microbial and anti-biofilm activities at concentrations below the cytotoxic threshold on normal mammalian cells. Accordingly, many synthetic cannabinoids have been designed with the intention to increase the specificity and selectivity of the compounds. The structurally unrelated endocannabinoids have also been found to have anti-microbial and anti-biofilm activities. Recent data suggest for a mutual communication between the endocannabinoid system and the gut microbiota. The present review focuses on the anti-microbial activities of phytocannabinoids and endocannabinoids integrated with some selected issues of their many physiological and pharmacological activities.
Bolin Li,1 Chunyan Liu,2,3 Ze-hui Fang,4 Ying Cao,4 Zheng Zhou,3 Haiyan Lu2 1Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School & Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, People’s Republic of China; 2Department of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School & Hospital of Stomatology, Hebei Medical University, Shijiazhuang 050017, People’s Republic of China; 3School of Dentistry, University of Detroit Mercy, Detroit, Michigan 48208, USA; 4School & Hospital of Stomatology, Anhui Medical University, Hefei 230032, People’s Republic of ChinaCorrespondence: Zheng ZhouSchool of Dentistry, University of Detroit Mercy, 2700 Martin Luther King Jr. Blvd, Detroit, Michigan 48208, USATel +1-313-494-6667Fax +1-313-494-6666Email zhouzh1@udmercy.eduHaiyan LuDepartment of Orthodontics, Hebei Key Laboratory of Stomatology, Hebei Clinical Research Center for Oral Diseases, School & Hospital of Stomatology, Hebei Medical University, 383 Zhongshan East Road, Shijiazhuang, Hebei 050017, People’s Republic of ChinaTel/Fax +86 311-86265748Email luhaiyan67@163.comBackground: Dentin hypersensitivity (DH) is a common dental clinical condition presented with a short and sharp pain in response to physical and chemical stimuli. Currently no treatment regimen demonstrates long-lasting efficacy in treating DH, and unesthetic yellow tooth color is a concern to many patients with DH.Aim: To develop a bi-functional material which can occlude dentinal tubules in-depth and remineralize dentin for long-lasting protection of the dentin–pulp complex from stimuli and bleach the tooth at the same time.Methods: A mixture containing CaO, H3PO4, polyethylene glycol and H2O2 at a specific ratio was mechanically ground using a planetary ball. The mineralizing complex paste was characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM). Dentin was exposed to the synthesized paste for 8 h and 24 h in vitro. The mineralizing property was evaluated using SEM and microhardness tests. Red tea-stained tooth slices were exposed to the synthesized paste for 8 h and 24 h in vitro. The bleaching effect was characterized by a spectrophotometer.Results: The complex paste had very a fine texture, was injectable, and had a gel-like property with 2.6 (mass/volume) % H2O2 concentration. The X-ray diffraction pattern showed that the inorganic phase was mainly monetite (CaHPO4). The mineralizing complex paste induced the growth of inorganic crystals on the dentin surface and in-depth occlusion of dentin tubules by up to 80 μm. The regenerated crystals were integrated into the dentin tissue on the dentin surface and the wall of dentinal tubules with a microhardness of up to 126 MPa (versus 137 Mpa for dentin). The paste also bleached the stained dental slices.Conclusion: The mineralizing complex paste is a promising innovative material for efficient DH management by remineralizing dentin and in-depth occlusion of dentin tubules, as well as tooth bleaching.Keywords: dentin hypersensitivity, remineralization, tooth whitening, planetary ball mill
Following greater attention and follow-up of patients with treated pulmonary tuberculosis (TB), it has emerged that infections are more likely to occur in this cohort of patients. This comes as no surprise, as pulmonary TB is a destructive process that leads to cicatrization, alteration of parenchyma, bronchiectasis, and scarring of the lung, with reduction of lung volumes and an impact on pulmonary function. In addition to relapse and re-infection with TB, other pathogens are increasingly recognized in post-TB patients. This paper serves as a summary and guide on how to approach the post-TB patient with new signs and symptoms of pulmonary infection in order to ensure optimal management and rehabilitation. Keywords: Tuberculosis, Post-treatment complication, Sequelae, Pulmonary rehabilitation, NTM, Bronchiectasis
Ifeanyichukwu Igwilo Onah, Chuwuemeka Patrick Okoye, Edward Bala
Background: Surgical treatment of clefts during infancy poses a challenge for the plastic surgeon and anesthetists. The timing of the procedures has been fraught with controversies with no consensus. Due to the many different treatment philosophies, the timing of treatment varies among cleft centers. Historically, anesthetic risk-related data suggest that the safe time period for surgery in this population of infants could be outlined by the rule of 10's. However, more sophisticated pediatric techniques and advances in intraoperative monitoring and pediatric anesthesia have resulted in the provision of safe general anesthesia for younger infants. This article attempts to provide an audit of the outcome and complications of cleft lip/palate repair performed earlier than the hitherto defined period. Aims/Objectives: The aims of the study were to evaluate the perioperative safety profile of early cleft lip and palate repairs and to evaluate early postoperative surgical complications. Materials and Methods: A retrospective audit of all patients that had early cleft lip and palate repair at the National Orthopedic Hospital Enugu, Nigeria, between May 2006 and May 2014. Early cleft lip and palate repairs were defined as repair done before 10 weeks and 9 months, respectively. Information was obtained from the folders of the patients and the smile train express database. The anesthetic technique was general anesthesia with endotracheal intubation and halothane as the inhalational agent. Armored tubes were used for palatal repairs. The Mohler's technique and Mulliken's technique were used for unilateral and bilateral lip repair, respectively. Intravelar veloplasty ± relaxing incisions/Bardach two-flap palatoplasty were used for palate repairs. All the procedures were carried out by one consultant plastic surgeon. Results: Four hundred and ninety-three cleft-related surgeries were performed in the period. Forty-one were early cleft lip/palate repairs. Thirty-one of these early procedures were done on the lip, whereas ten procedures were on the palate. There were no mortalities. One patient (2.4%) developed anesthetic complication (prolonged recovery time). There was neither need for intra- nor postoperative transfusion. One patient had a need for supplemental oxygen therapy beyond 1 h. There was no need to take any patient back to theater. The most common early complications following lip and palate repairs were wound dehiscence and palatal fistulae, respectively. Conclusion/Recommendation: These procedures can be safely carried out when performed early. The surgical complication rates appear to be few following early procedures. Further study on long-term cleft repair on facial growth and speech needed.