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Evaluation of the Conformity of Care of Patients Hospitalized for Cervico-Facial Odontogenic Cellulitis in Yaounde-Cameroon

Introduction: Cervicofacial odontogenic cellulitis is a poly-bacterial inflammatory process of the cellulo-adipal tissue involving the dental organ. The severity of its clinical picture can compromise its treatment and cause death. The vital prognosis of a hospitalized patient depends on the conformity of his management conditions. It is in this perspective that this study was carried out with the aim of evaluating the conformity of care of patients hospitalised for odontogenic cervico-facial cellulitis in Yaounde. Material and method: This was a descriptive and retrospective study that took place over 7 months during 2022, including all patients hospitalised for cervico-facial cellulitis of oral origin during a 3-year period, from 1er January 2019 to 31 December 2021 at the Yaoundé Central Hospital (HCY), the Yaoundé University Hospital (CHUY) and the Efoulan District Hospital (HDE). Socio-demographic characteristics, clinical and therapeutic aspects, and compliance with management were recorded. Data collection was done with a pre-designed form and the results were processed and analysed using SPSS version 26.0 and Excel 2013. Results: Out of 134 patient records collected, 67% were male with a sex ratio of 2.04. The age range Age group The age group [20-40] represented 56% of the cases. About 52.2% of the patients worked in the informal sector, followed by 25.4% of pupils and students. Trismus was present in 92.5% of cases. Cellulitis was diffuse in 81.3% of cases, suppurative in 73.9% and acute in 71.6%. Dual therapy with 99.3% Penicillin and 97.8% Imidazole was used in 69.4% of cases; the first level of Paracetamol was used in 94% as an analgesic. Antimalarial drugs were associated with the initial treatment in 5.2% of cases. Incision and drainage used in 52% of cases. The prescribed care was notified and regularly administered in 73.1% of cases; the case fatality rate was 15.7%, with sepsis as the cause in 80% of cases. All the records included the identification, the reason for hospitalisation and the therapeutic prescription. The elements of the hospitalization report, the prescription established at discharge and the conclusion of the clinical examination were contained in 84.3%, 94.8% and 97.8% of cases respectively. Conclusion: cellulitis affects resourceful men. Even if the compliance of the management conditions was found to be fair, the prognosis is vital with the severity of the infection.

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Counts of Damage Assessed following Head and Neck Cellulitis of Oral Origin

Introduction: Cellulite is an inflammatory process of bacterial origin of cellulo-adipose tissue. Its evolution and management can be marked by complications that can induce sequelae to patients. The purpose of the study was to determine the counts of harm assessed following surgical management of head and neck cellulitis of oral origin in three hospitals in Yaounde. Methodology: A descriptive and retrospective study was conducted in three hospitals in the city of Yaounde during 2021 for 7 months. Included in our research were patients surgically treated for head and neck cellulitis from January 2010 to December 2018. The data collection was done with a pre-designed sheet and the analysis of the results obtained using the EPI info 7.2.2.6 software. Results: Out of 352 patients collected, male accounted for 63% of cases with a sex ratio of 1.69. The average age was 32.52 ± 11.4 years with extremes ranging from 1 to 73 years. About 46.88% worked in the informal sector. The main functional sequelae were edentulism (68.75%), and the average permanent functional deficit (PFD) was 1.61% ±1.15 with extremes between 0 and 7%. Permanent aesthetic damage (PEP) was mostly very mild, rated at 1/7 in 86.65% of cases. The suffering endured (SE) was mainly very mild, at 1/7 in 91.19% of cases. Conclusion: The counts of harm assessed following odontogenic head and neck cellulitis were aesthetic harm, suffering endured and permanent functional deficit.

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In Vitro Antifungal Susceptibility of Candida Albicans Isolated from Yemeni Patients with Denture Stomatitis

Background and aims: Candida-associated denture stomatitis (CADS) is a common fungal infection in people who wear dentures. The main objectives of this study were to identify the causative agents of CADS and in vitro antifungal susceptibility testing (AFST) for Candida albicans in Yemeni patients with denture stomatitis. Methods: A total of 88 Candida spp. obtained from patients with denture stomatitis. Candida spp were identified using standard microbiological methods. The in-vitro antifungal susceptibility of Candida albicans. to fluconazole (FCZ), itraconazole (ICZ), voriconazole (VCZ), and amphotericin B (AMB) was evaluated using the E test strips. Interpretive sensitivity criteria for antifungal breakpoints were adapted from the Clinical and Laboratory Standards Institute (CLSI). Results: Overall, C. albicans was the most commonly isolated species (𝑛 = 60; 68.2%), followed by C. glabrata (𝑛 = 9; 10.2%), C. tropicalis (𝑛 = 7; 8%), and C. parapsilosis (𝑛 = 3; 3.4%). Voriconazole had the lowest geometric mean minimum inhibitory concentration which was 0.0418 𝜇g/ml for MIC50, and 0.957 𝜇g/ml for MIC90; followed by amphotericin B (AMB) in which MIC50 was 0.518 𝜇g/ml and for MIC90 was 1.06 𝜇g/ml. Conclusion: Our study showed that Candida albicans was the most prevalent Candida species in Yemeni patients with CADS and was susceptible to both azoles and amphotericin B. In addition, voriconazole could be a suitable alternative to antifungal agents currently used in the treatment of CADS, as well as in the treatment of recurrent Candidasis.

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Microscopy Analyses Reveal the Parasitism of Entamoeba gingivalis in Periodontitis: An Observational Study

Background: Whereas the periodontal microbiota is well described, its non-bacterial component needs a better understanding. Metagenomic analyses show a strong increase of the protozoan Entamoeba gingivalis in inflamed periodontal pockets. Its presence is associated with periodontal deterioration and pockets typically 3mm or more in depth. The aim of this study is to observe the amoeba within the biofilm during active disease. Materials and Methods: Here, we present results of a phase contrast microscopy-based observation of amoebae in periodontal patients’ subgingival plaque from infected sulcus. Plaque samples from deepest part of sulcus are picked up and spread out between blade and coverslip in patient saliva medium. We relate significant behavior of the parasite during active periodontal disease. Results: From low power observation, parasite is quite frequent. Once targeted, high power observation confirms amoeban anatomy and presence. We observed a high degree of amoeba locomotion and movements toward specific environments within the subgingival plaque. This was accompanied by the formation of “channels” within the biofilm. We also present evidence of adhesion to human cells as well as characteristically parasitic behavior. Specifically, we observed the intrusion of amoeba pseudopods into leukocytes coupled with a decrease in leukocyte intracellular granular activity. We documented both single trogocytic processes and trogocytosis through multiple pseudopods. In addition to leukocytes, we also observed trogocytosis of red blood cells. Parasitic behavior was also evident from the observation of amoebae digesting the nuclei of multiple vacuolar white blood cells, simultaneously. Following trogocytosis, polynuclear neutrophils had the appearance of ghost cells. Finally, we show evidence for amoeba nesting and reproduction within periodontal pockets. Conclusion: Phase contrast microscopy of periodontal biofilms strongly suggests that E. gingivalis escapes the first lines of innate defenses and promotes a pathological state. Trogocytosis and exonucleophagy processes targeting neutrophils could consequently disrupt neutrophil extracellular traps activity and normal apoptotic function, a vital component of wound healing. This study points to Entamoeba gingivalis as a microbe involved in the inflammatory process during periodontitis and as a driver of the disease rather than a harmless commensal species.

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Complex Treatment of Internal TMJ Disorders in Patients with Different Bit Types

Objective: To assess the impact of physiological and pathological types of occlusion on the effectiveness of the treatment of patients with internal disorders of the TMJ. Material and Methods: A comprehensive examination and treatment of 139 patients with internal TMJ disorders with subluxation and chronic dislocation of the articular disc was carried out. The patients were divided into three groups. All groups included patients with both physiological and pathological occlusion. The first group included 28 (20.1%) patients who were treated only with occlusal splint therapy; the second group included 95 (68.3%) patients who were treated with a combination of occlusal splint therapy and the use of arthrocentesis; in the third group (16 people (11.5%), along with splint therapy and arthrocentesis, TMJ arthroscopy was performed. The examination included a survey and examination of patients, a study of diagnostic models of the jaws to determine the types of occlusion and occlusal contacts, magnetic resonance imaging (MRI) and ultrasound examination (ultrasound) of the TMJ. Patients underwent a phased treatment, including occlusive splint therapy (stage I); with insufficient effectiveness - occlusive splint therapy and arthrocentesis (stage II); occlusive splint therapy and arthrocentesis in combination with arthroscopy (stage III of treatment). Results: As a result of the study, it turned out that the groups of patients differed significantly in the complexity and duration of the treatment. Thus, in patients with internal TMJ disorders and pathological type of occlusion, in 82.6% of cases, additional use of arthrocentesis was required and in 34.8% - arthroscopy (95 patients out of 139), while patients with physiological types of occlusion (orthognathic, progenic, biprogenic and direct) needed these treatments in 80.2% and 7.8% of cases, respectively In the groups of patients, the duration of therapy, as well as the number of arthrocentesis performed in patients at the second and third stages of treatment, significantly differed. In the first group, the duration of treatment was 6.2 months for patients with normal occlusion and 8.7 (p<0.01) months for patients with pathological occlusion; additional methods of treatment (arthrocentesis and arthroscopy) were not used. In the second and third groups of patients, the duration of treatment for patients with occlusion pathology was also longer: in the second group 4.9 and 6.8 (p<0.01) months for patients with physiological and pathological types of occlusion, respectively, in the third group with the use of splint therapy, arthrocentesis and arthroscopy in patients with normal occlusion was 13.1 (p<0.05) months, and in patients with occlusion pathology 14.5 months Conclusion: Patients with internal TMJ disorders need a comprehensive examination for the timely detection of occlusion pathologies. The relationship between internal TMJ disorders and the type of occlusion must always be taken into account in the choice of further treatment tactics and therapy planning in order to achieve the best result.

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Gingival Parasitic Infections as a Contributor to Periodontitis: Identification and Treatment

Objectives: Parasites play a role in the pathology of periodontal disease with the protozoan Entamoeba gingivalis frequently observed when periodontal disease is present and has been ignored as a contributor to periodontal disease. Identification of the presence of periodontal parasites and how to treat them to eliminate their contribution to periodontal disease will be addressed. Methods: The first phase of therapy is reconstituting a normal commensal biofilm with minimal supragingival calculus removal to limit potential for the parasites to invade the soft tissue lining of the pocket and potentially spread related to the bleeding capillaries. At the fourth month, a systemic antiparasitic medication (metronidazole) is added. The second phase of therapy consists of four monthly subgingival calculus removal using sonic or ultrasonic instruments. Microscopic evaluation is used to confirm the absence of parasites. Results: The Bonner Method is nonsurgical. Pocket closure and osseous regrowth, without supplemental grafting help confirm healing and continued use of the homecare regime allow the patient to maintain gingival health long-term. Microbiota microscopic examination at every visit during active treatment confirms healing and elimination of the parasites. Conclusions: Patient who have traditionally avoided dental treatment or have experienced traditional surgery in the past easily accept antiparasitic treatment, which is reached from clinical and microscopic co-examination. Many of these patients are seeking an alternative to traditional surgery and are more comfortable with the basics behind the protocol once they have seen their biofilm under video from their microscopic sampling. Clinical significance: The subject of this article has clinical relevance, as parasites are an unrecognized contributor to periodontal disease that is frequently not identified or understood. This article discusses its clinical relevance, how to identify its presence and treatment to eliminate the parasite as part of periodontal treatment. The authors feel that this will have relevance to dental hygienists as they are the practitioner who would be first to identify its presence and provide treatment in the dental practice.

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Maximum Mouth Opening among Libyan Population

Restricted mouth opening may be associated with musculoskeletal disorder or due to orofacial infections and trauma, as well as chronic condition such as disorders of the temporomandibular joint and tumors. Aim This study was aimed to measure the maximum mouth opening among the young healthy patients of Sirte city. Methods A total of 100 participates, 42 males and 58 females, in the age range of 12-20 years attending the orthodontic clinic in Sirte city were studied. The Participates were asked to open their mouth maximally until no further opening was possible. The distance from the incisal edge of the upper incisor teeth to the incisal edge of the lower incisor teeth was measured using a digital calibrated. All data were analyzed using SPSS program and simple descriptive statistics of MMO with regard to gender and age were reported. Results The mean maximal mouth opening for males was 49.35(4.5) mm and mean maximal mouth opening for females was 47. 11(4.7) mm. Mouth opening differences among different gender was compared which showed male had wider mouth opening but the difference was not statistically significant. Statistically significant differences were found between age groups. Conclusions The results of this study indicated that the positive relationship between MMO and age and the base line data was achieved in our study which needs to be validated further by conducting study in larger population.

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