Etiological Factors Research Articles

Proposal of a New Therapeutic Classification in Gingival Smiles Focused on Treatment with Semi-Permanent Infiltrations.

A gummy smile, defined as excessive gingival exposure while smiling, is an esthetic and functional condition affecting an individual's quality of life. Despite its prevalence and impact, the classification and treatment of the gummy smile remain challenging in clinical practice. The problem lies in (1) the fact that the etiology of this pathology is multifactorial, and these factors sometimes go unnoticed, (2) the lack of consensus on the classification criteria, which, together, create (3) challenges in designing an optimal treatment plan for each patient. This article reviews the etiologic factors of this condition as the main basis for understanding the existing classifications of the gummy smile. It highlights the importance of muscle dynamics in the genesis and treatment of this clinical condition. We present a new, treatment-oriented classification that integrates the muscle hyperactivity present within the classification criteria and explore the implication of this interaction in the design of effective treatments. The ultimate goal of this present work is to improve the clinical understanding of the gingival smile and offer more personalized treatment strategies, through a more complete classification.

5155 Benign Paroxysmal Positional Vertigo as a Potential Manifestation of Hypothyroidism, a Case Report

Abstract Disclosure: M. Ahmad: None. M. Herrera: None. D. Deyar: None. P. Gill: None. Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is a vestibular disorder characterized by recurrent episodes of vertigo triggered by specific head movements. The pathophysiology of BPPV involves the displacement of otoconia within the semicircular canals of the inner ear. However, emerging evidence suggests that BPPV may manifest as a consequence of hypothyroidism. In this case report, we present a clinical case of a patient who exhibited symptoms of BPPV and was subsequently diagnosed with hypothyroidism. We aim to elucidate the relationship between these two seemingly distinct conditions and highlight the importance of considering hypothyroidism as a potential cause of BPPV. Case presentation: A 56-year-old female with a past medical history of migraines presented to the hospital for three days of dizziness. She had multiple bouts of vomiting and right-sided headaches similar to her prior migraine headaches. The patient also noted dry skin, constipation, and hair loss for the past few months. The patient’s vital signs were as follows: temperature: 35.6 C, heart rate: 65 beats per minute, blood pressure: 153/66 mmHg, and respiratory rate: 18 breaths per minute. On physical examination, the Dix-Hallpike maneuver was positive on the right side and the patient was noted to have diffusely dry skin. The patient’s labs were significant for the following: sodium: 137 mmol/L, potassium: 3.7 mmol/L, creatinine: 0.88 mg/dL, thyroid stimulating hormone: 31.2 uIU/ml, free T4 ng/dL, hemoglobin: 10.8 g/dL (MCV of 87), and TPO antibody: 2350 IU/ml. The patient underwent CT and MRI imaging of the brain without contrast, which was negative for any acute intracranial abnormalities. The patient was diagnosed with BPPV and hypothyroidism secondary to Hashimoto’s thyroiditis and subsequently underwent vestibular physical therapy with improvement in her vertigo and was started on 112 mcg of levothyroxine daily. She is set to follow up with her primary care provider as an outpatient. Discussion: BPPV generates significant repercussions to an individual’s quality of life, autonomy, and functionality. Hypothyroidism is a common condition characterized by thyroid hormone deficiency that has been linked with a wide array of clinical manifestations, including vestibular disturbances. Autoimmune dysfunction, anomalies of the endolymphatic flow and low perfusion to the inner ear are potential etiological factors that can explain the relationship between thyroid disorders with BPPV. Some studies mention that thyroid autoantibodies could induce autoimmune-complex deposition in the inner ear, which might change the endolymphatic flow and induce BPPV. Raising awareness regarding this potential manifestation of hypothyroidism can guide clinical and diagnostic decisions that improve patient care, especially in individuals under evaluation for BPPV with other symptoms of hypothyroidism. Presentation: 6/3/2024

Prevalence and Correlations of Premenstrual Dysphoric Disorder: A Sample of Adult Working Women.

Premenstrual dysphoric disorder (PMDD) represents a significant psychiatric condition affecting women of reproductive age. It is characterized by cyclical emotional and physical symptoms that considerably impair psychosocial functioning. This study aims to investigate the prevalence of PMDD among adult working women and identify associated etiological factors. From January 2022 to March 2022, a cross-sectional study utilizing cluster sampling methodology was conducted to investigate the prevalence of PMDD among adult working women in six communities in Hangzhou (China). A total of 1710 participants were selected for research through a questionnaire-based survey. To elucidate the factors associated with PMDD, logistic regression analysis was employed. Among 1710 working women, 52 had PMDD, representing an incidence of 3.04%. Age (odds ratio (OR) = 3.196, p = 0.002), age at menarche (OR = 0.362, p = 0.011), income (OR = 0.449, p = 0.043), menstrual cycle (OR = 2.352, p = 0.022), menstrual symptoms (OR = 0.317, p = 0.003), physical activity (OR = 2.234, p = 0.028), and caffeine intake (OR = 2.318, p = 0.022) were independent influencing factors of PMDD in adult working women. The study highlights that PMDD, which has a prevalence of 3.04% in the surveyed population, is a notable concern among adult working women. Key factors, such as age, age at menarche, income level, menstrual cycle characteristics, menstrual symptom presence, physical activity, and caffeine intake, significantly contribute to the likelihood of developing PMDD. These findings underscore the importance of recognizing and monitoring the above risk factors by clinicians to identify and manage PMDD in working women.

7944 Elevated Serum Alkaline Phosphatase without other Abnormalities of Liver Associated Enzymes as an early Indicator of Glucose Intolerance: A Case Series

Abstract Disclosure: B.K. Bowens: None. C. Godar: None. D. LaChance: None. T.D. Hoang: None. M.K. Shakir: None. Glucose intolerance (GI) is defined as dysglycemia and includes impaired fasting glucose, impaired glucose tolerance, and prediabetes. Early detection of GI could lead to appropriate treatment and delay the progression to diabetes mellitus. The cases below detail two patients with elevated serum alkaline phosphatase (ALP) without other liver-associated enzyme abnormalities as an early indicator of GI. Case 1: A 54-year-old woman with a history of multinodular goiter status post thyroidectomy (2020), adrenal incidentaloma (2016), and asthma was incidentally found to have an elevated HbA1C (A1C) of 6.3% on screening labs in 2015. At that time, her ALP was 73 IU/L (ref 44−121). Her ALP levels slowly rose from 88 to 152 IU/L by September 2020. Work up did not reveal any etiological factors for the elevated ALP. One month later, HbA1C was found to be 7.6%. Metformin was initiated with improvement in A1C to 6.3% with an ALP of 130 IU/L. However, metformin was discontinued due to intolerance. In April 2023, her A1C was 9.3% with an ALP of 134 IU/L. A1C rose to 12.8% in Jun 2023 at which time she was started on insulin glargine, insulin aspart, sitagliptin, and was restarted on metformin. Her A1C decreased to 8.6% in August 2023 with normalization of ALP to 88 IU/L. Case 2: A 53-year-old woman with a history of hypertension, hyperlipidemia, obstructive sleep apnea, and non-ischemic cardiomyopathy in 2004 was found to have an elevated A1C of 5.8% on her screening labs in Jun 2019. Her ALP was notably in the high-normal range until Oct 2021 when it was found to be 138 IU/L. Her most recent A1C was 5.9% with an ALP of 142 IU/L. The patient was started on semaglutide (WegovyTM) briefly but was unable to tolerate the side effects. She was then started on metformin 500mg BID and dulaglutide with normalized ALP level. Discussion: Emerging evidence has shown that serum ALP activity is modestly increased in cardiometabolic diseases such as type 2 diabetes, dyslipidemia, hypertension, and peripheral arterial disease. These are increasingly being considered as inflammatory disorders and it has been shown that serum ALP level was positively and independently associated with metabolic syndrome both in men and women. It is possible that ALP could be an indicator of non-alcoholic fatty liver disease (NAFLD) which is associated with GI. Typically, NAFLD presents with higher ALT and GGT, however, occasionally isolated enzyme elevations or no elevated enzymes at all may occur. Conclusion: These cases suggest that an isolated elevation in ALP could be indicative of GI. Patients incidentally found to have an elevated ALP should be worked up further for possible evidence of GI. Early detection of GI could delay progression to diabetes and decrease morbidity. Presentation: 6/1/2024

The association between interdental cleaning and periodontitis in an urban Thai adult cohort: a cross-sectional study.

Plaque biofilm is a major etiologic factor of periodontitis, and its effective removal prevents or ameliorates the disease. However, toothbrushing alone does not sufficiently clean the interdental area, and additional interdental cleaning is required to completely remove the plaque from this locale. This cross-sectional study aimed to assess the association of interdental cleaning on the prevalence of periodontitis in a large urban Thai adult cohort. Interdental cleaning data were retrieved from a dental survey of 1,743 employees of the Electricity Generating Authority of Thailand (EGAT) in 2019. The Centers for Disease Control and Prevention/American Association of Periodontology (CDC/AAP) periodontal case definitions were applied. The participants were subdivided into two groups as those with or without periodontitis depending on their oral health status assessed by calibrated professional examiners. The proportion of subjects who performed interdental cleaning was assessed through a self-reported questionnaire by frequency (daily/ ≥ 1 per week/ none) and profile (correct/ incorrect) of interdental cleaning. Then, the association between interdental cleaning and periodontitis was calculated using logistic regression analysis controlling for the common risk factors of periodontitis such as age, sex, education, smoking, and diabetes. Participants who performed interdental cleaning on a daily basis and ≥ 1 per week were 27.5% (95% CI: 25.4, 29.6) and 29.1% (95% CI: 27.0, 31.3), respectively while the remainder did not practice. Of those who used interdental cleaning, about one-half focused on sites with food impaction. There was a significant 44% lower prevalence of periodontitis (adjusted odds ratio of 0.56 (95%CI: 0.40, 0.79) in the cohort with a frequent and correct group. Our data indicate an inverse association between interdental cleaning and periodontitis, particularly in those who routinely adhered to it. Regular interdental cleaning is likely to have a salutary effect on oral health. The study was registered retrospectively in Thai Clinical Trials Registry, Registration number: TCTR20240817005, on 17 Aug 2024 ( https://www.thaiclinicaltrials.org ).

Sign language delays in deaf 3- to 5-year-olds with hearing parents.

Deaf children of hearing parents (DOH) are at risk for early language delays (ELD) due to environmental and etiological factors, compounding the previously reported higher incidence of ELD in deaf children of deaf parents (DOD) compared to the general population. Archival data from the online database of the Visual Communication and Sign Language Checklist yielded 147 ratings of DOH 3- to 5-year-old children whose parents reported American sign language (ASL) being used in the home at least equally to spoken language. Research goals included (1) examining the incidence of ELD in this cohort, (2) investigating differences in outcomes based on the scaling method used, (3) exploring patterns among the ratings of DOH children identified with ELD, (4) comparing the DOH outcomes to published DOD data, and (5) investigating differences between ratings and individual children. The DOH outcomes suggested an incidence of ELD twice that of the previous DOD sample, with a higher percentage of more severe delays. Even DOH children not identified with ELD demonstrated less well-developed ASL skills than their DOD peers. This emphasizes the need for ongoing monitoring of early ASL skills to allow for early identification of needs and adjustment of interventions to address ASL development.

Salivary microbiota reflecting changes in subgingival microbiota.

The salivary microbiota has attracted increasing attention as a promising method for monitoring periodontal disease. With regard to the pathogenesis of periodontal disease, however, subgingival plaque microbiota is the dominant etiological factor. Although it has been established that periodontopathogenic bacteria exist in saliva and their distribution differs, depending on the severity of the disease, it is necessary to analyze the extent to which the salivary microbiota reflects the subgingival microbiota. This study explored whether subgingival microbial changes according to the severity of periodontal disease and following the non-surgical periodontal treatment of periodontitis are reflected in the saliva microbiota and concluded that the salivary microbiota can reflect changes in the subgingival microbiota. Saliva can be used as a diagnostic tool to monitor the periodontal health status of individuals.

Excitation-inhibition imbalance in medial preoptic area circuits underlies chronic stress-induced depression-like states

Dysregulation of brain homeostasis is associated with neuropsychiatric conditions such as major depressive disorder. However, underlying neural-circuit mechanisms remain not well-understood. We show in mice that chronic restraint stress (CRS) and social defeat stress (SDS) are both associated with disruption of excitation (E)-inhibition (I) balance, with increased E/I ratios, in medial preoptic area (MPOA) circuits, but through affecting different neuronal types. CRS results in elevated activity in glutamatergic neurons, and their suppression mitigates CRS-induced depressive-like behaviors. Paraventricular hypothalamic input to these neurons contributes to induction but not expression of depressive-like behaviors. Their projections to ventral tegmental area and periaqueductal gray/dorsal raphe suppress midbrain dopaminergic and serotonergic activity, respectively, and mediate expression of divergent depressive-like symptoms. By contrast, SDS results in reduced activity of GABAergic neurons, and their activation alleviates SDS-induced depressive-like behaviors. Thus, E/I imbalance with relatively increased excitation in MPOA circuits may be a general mechanism underlying depression caused by different etiological factors.

Predominantly antibody deficiencies: An important underlying cause of recurrent pneumonia in adults

RATIONALE Limited information exists concerning the causes of recurrent pneumonia in adults, particularly regarding immunodeficiencies or inborn errors of immunity. OBJECTIVES This study aims to evaluate the etiology of recurrent pneumonia in the adult population, with a focus on humoral deficiency and inborn errors of immunity. METHODS A cross-sectional non-interventional study was conducted in Cali, Colombia, from January 2019 to March 2021. Consecutive patients, aged over 14 years but under 65 years, with a history of recurrent pneumonia, were included after providing consent. The study involved a thorough review of their past medical records and radiological studies. All participants underwent complete blood count and serum immunoglobulin level measurements (IgG, IgA, IgM and IgE). Further testing was carried out based on the evaluation of a clinical immunologist. RESULTS Sixty-six (66) individuals, comprising 34 females and 32 males, were enrolled in the study. The onset of symptoms occurred at an average age of 14 years (ranging from 5 to 36 years). The analysis revealed that the most prevalent cause of recurrent pneumonia was inborn errors of immunity (20 cases, 30.3%), followed by idiopathic (9 cases, 13.7%), bronchiectasis (7 cases, 10.7%), primary ciliary dyskinesia (6 cases, 9.0%), asthma (6 cases, 9.0%), and post-tuberculosis complications (5 cases, 7.6%). CONCLUSION Predominantly antibody deficiencies, along with other inborn errors of immunity, were identified as an important factor contributing to recurrent pneumonia in adults. These findings highlight the importance of these conditions as major etiological factors in the context of recurrent pneumonia in the Colombian adult population.

Ectopic Tooth Eruption – Integrative Literature Review

Ectopic eruption designates teeth that deviate from their normal eruption pattern. Its multifactorial etiology includes local and systemic factors, somatic disorders, and genetics. The objective of this study is to know the most common teeth that can present ectopic eruption, their prevalence, and associated clinical factors. A bibliographic search of scientific articles indexed in the PUBMED® and VHL databases was performed in September 2023, with the following descriptors: "Tooth Eruption; Ectopic; Dentistry". A total of 42 articles published in the last 5 years were found. Of these, 16 addressed ectopic eruptions and were included. The reviewed literature highlights the following clinical aspects: delayed eruption, partial appearance of the crown, changes in the eruption axis, transpositions, and gyro versions. The most affected teeth are the first permanent molars, with approximately 2 to 6%, and the canines with approximately 1.5 to 4.6%. It is essential to diagnose ectopic eruption early and identify the etiological factors, to obtain early treatment, preventing the development of this pathology and, consequently, the appearance of malocclusion.

Should Gallbladder Pathologies Be Investigated in Patients With Colon Polyps?

Background Data regarding the frequency of development of gallbladder pathologies in patients with colon polyps are quite limited and heterogeneous. Hence, this study aimed to investigate whether colon polyps cause an increased risk of developing gallbladder pathologies and the necessity of ultrasonographic screening. Methodology This retrospective, cross-sectional study was conducted among adult patients who underwent a colonoscopy and hepatobiliary ultrasound as part of their health check-up from January 2018to January 2023. The frequency, etiological factors, and association of gallbladder pathologies with colon polyps were investigated. Results A total of 128 patients were included in the study. When the distribution of colon polyp pathology was examined, 78.9% (n = 101) were adenomas, 18.8% (n = 24) were non-neoplastic polyps, and 2.3% (n = 3) were adenocarcinomas. The rate of patients with gallbladder stones was 10.9% (n = 14) and the rate of patients with polyps was 18.8% (n = 24). On multivariate logistic regression analysis, variables found to be significant for the development of gallbladder pathologies were determined as obesity, hyperlipidemia, and polyp's distal colon location. Conclusions Obesity and metabolic syndrome were among the etiological factors in this patient group. Hepatobiliary ultrasound, a non-invasive and inexpensive examination, is useful in patients with colon polyps.

Imaging Descriptors of Human Papilloma Virus-mediated and Human Papilloma Virus-negative Oropharyngeal Cancers in Indian Subcontinental Patients

Abstract Background: Nearly 24,000 new cases of oropharyngeal cancers (OPCs) are reported per year in India, constituting 3.9% of cancers in all sites. By 2009, Human papilloma virus (HPV), in particular HPV-16, was established as an etiological factor and even a causative agent in OPCs being associated with up to 70% OPCs. Prior imaging-based studies have described certain differentiating factors between HPV-mediated and HPV-negative OPC, highlighting computed tomography and magnetic resonance characteristics that could help differentiate the two groups. Our study aimed to evaluate any imaging differences between HPV-mediated and non-HPV-mediated oropharyngeal malignancies in the Indian subcontinent population. Methods: Seventy-nine patients from the Indian subcontinent who were referred to a tertiary center in southern India between the period of January 2019 to September 2020 (19 months) were included in the study. Imaging descriptors were documented by blinded radiologists, and univariate and multivariate analysis of various imaging descriptors and imaging differences between HPV-mediated and non-HPV cases were attempted to be identified. Results: We found no statistically significant imaging differences between HPV-mediated and non-HPV-mediated oropharyngeal malignancies. The only epidemiologically significant difference in the two groups was that in women and nonsmokers, HPV-mediated malignancies were more common. Conclusion: HPV-mediated and HPV-negative malignancies have similar primary tumor as well as nodal imaging characteristics. Previously cited differences in the two groups, in Western literature, could not be demonstrated in our population. It implores further research into whether downstaging of treatment and better prognosis of HPV-mediated malignancies is actually applicable in the Indian subcontinent setting.

Male factor infertility and implication of fertility treatment in low resource settings

Introduction: The prevalence of infertility has increased worldwide. The etiological factors are also changing in trend and prominence. Male infertility is driving the epidemic in many regions of the world. Therefore, the aim of this study was to explore male factor infertility in the Gambia. Methodology: The design was a longitudinal descriptive study of subfertile couples at a specialist tertiary hospital in Banjul, the Gambia, from August 2022 to May 2023. Data were extracted from patients folders and entered into a computer database. Descriptive statistics were used to analyze the data and results expressed in tables, graphs, and percentages. Results: Total number of subfertile couples analyzed was 152: male factor 69 (45.4%), ovulation disorder 34 (22.4%), tubal factor 20 (13.2%), uterine factor 8 (5.3%), and unexplained 21 (13.8%). The median age of male folk was 50 years, with an age range of 31 to 64 years. The rates of asthenoteratozospermia, oligospermia, and azospermia were 37.8%, 36.2%, and 26%, respectively. In azoospermic males, over 75% had elevated FSH (12–44 miu/mL). Conclusions: The prevalence of male infertility is at 45.4%, which is 3-fold and 2-fold higher than tubal and ovarian factors, respectively. Male infertility is a problem with obvious implications. The predominant types of male infertility we observed in this study will almost always require multidisciplinary care and ICSI.

Striosomes control dopamine via dual pathways paralleling canonical basal ganglia circuits.

Balanced activity of canonical direct D1 and indirect D2 basal ganglia pathways is considered a core requirement for normal movement, and their imbalance is an etiologic factor in movement and neuropsychiatric disorders. We present evidence for a conceptually equivalent pair of direct D1 and indirect D2 pathways that arise from striatal projection neurons (SPNs) of the striosome compartment rather than from SPNs of the matrix, as do the canonical pathways. These striosomal D1 (S-D1) and D2 (S-D2) pathways target substantia nigra dopamine-containing neurons instead of basal ganglia motor output nuclei. They modulate movement with net effects opposite to those exerted by the canonical pathways: S-D1 is net inhibitory and S-D2 is net excitatory. The S-D1 and S-D2 circuits likely influence motivation for learning and action, complementing and reorienting canonical pathway modulation. A major conceptual reformulation of the classic direct-indirect pathway model of basal ganglia function is needed, as well as reconsideration of the effects of D2-targeting therapeutic drugs.

Evaluating the impact of metabolic and cognitive stress on ghrelin and nesfatin-1 hormones in patients with diabetes and diabetic depression.

Nesfatin-1 and ghrelin, initially recognised as hormones involved in regulating energy, have emerged as crucial players with vital functions in various human body systems. In this study, we conducted a comparative assessment of nesfatin-1 and ghrelin responses in individuals experiencing metabolic stress due to diabetes, those with depressive diabetes characterised by both metabolic and mental stress, and healthy controls. We collected blood samples from a total of 90 participants, consisting of 30 people with type II diabetes mellitus (DM), 30 people with type II DM and major depressive disorders, and 30 healthy individuals. Diabetes was diagnosed based on glycated haemoglobin (HbA1c) levels, while depression was assessed using DSM-V criteria. Insulin resistance (HOMA-IR) was calculated, and serum ghrelin and nesfatin-1 levels were measured using ELISA kits. We observed statistically significant decreases in nesfatin-1 and ghrelin levels in the diabetic group (p<0.0001). However, in the depressive diabetic group, nesfatin-1 levels increased significantly, while ghrelin levels decreased further. The nesfatin-1 to ghrelin ratio decreased in the diabetic group but increased significantly in the depressive diabetic group (p<0.0001). Nesfatin-1 and ghrelin hormones exhibit parallel impacts in response to metabolic stress, but nesfatin-1 demonstrates contrasting actions compared to ghrelin when mental stress is added to metabolic stress. The findings of this study suggest that nesfatin-1 and ghrelin hormones may play active roles as protective, prognostic, and even etiological factors in various stress situations, particularly those involving mental stress, in addition to their known functions in regulating energy.

Development and Evaluation of Project Management Training for Cancer Research in Sub-Saharan Africa.

Globally, there were 19.3 million new cancer cases and 10 million cancer deaths, with the African continent contributing approximately 1.1 million new cases and over 700,000 deaths to the global cancer burden in 2020. High quality research is required to understand the etiology and risk factors for common cancers in the region to develop context specific strategies aimed at minimizing the future cancer burden in Africa. Our study addresses a significant gap in the knowledge and resources available for training a project management (PM) workforce for cancer research in Africa. We developed and evaluated a training program to strengthen the research capacity of project managers involved in cancer research in Africa. This workshop was held in collaboration with the Men of African Descent and Carcinoma of the Prostate (MADCaP) Consortium. The PM working group of the MADCaP Consortium had previously developed a project manager toolkit to provide a structured approach to PM for cancer research in Africa. We implemented and evaluated this training toolkit in a hybrid workshop in Nigeria. Among 29 participants from 10 African institutions, PM skills improved after training by 16.6% compared with pretraining levels. In a 1-year follow-up survey, training skills remained better (80.8%) than before the training (70.8%). The training program successfully upskilled the trainees with a significant improvement in knowledge of PM practices including planning, execution, monitoring, and evaluation of projects. The majority (80%) reported an excellent training experience. PM skills training can be successfully implemented in Africa with long-term retention of knowledge geared toward developing a workforce critical for the implementation of cancer research in the region.

New Onset Seizure in the Elderly: Classification, Etiology, and Impact on Quality of Life and Caregiver Burden

Abstract Objective The incidence of seizures is highest in the elderly, and their management is challenging in view of atypical presentation and comorbidities. The aims of this analysis were to study the classification, etiology, and risk factors in new onset seizures in the elderly (&gt;60 years) and their impact on the quality of life (QOL) and caregiver burden. Method All the elderly presenting to neurology, neurosurgery and emergency medicine OPD with new onset seizures after the age of 60 years were included. QOL and caregiver burden were assessed at least 6 months after the first seizure. The QOL was assessed with the World Health Organization Quality of Life OLD (WHOQOL-OLD) and was compared with age-matched controls. Caregiver burden was assessed with the Zarit Burden Interview. Result Eighty patients fulfilling the inclusion criteria and 80 age-matched controls were recruited. There was no difference in age (68.30 ± 6.22 vs. 69.09 ± 6.07 years; p = 0.39) and gender (M:F = 50:30 vs. 48:32; p = 0.74) among the cases and controls. Forty-four (55%) patients had focal seizure. Hypertension was the commonest risk factor (61.3%), followed by ethanol intake (40%) and diabetes (38.8%). Cerebrovascular disease was the commonest etiology (37.5%), followed by infection (15%). Thirteen (16.2%) patients died during hospital stay and 20 (25%) died after discharge from the hospital. Cases scored significantly low on all domains of WHOQOL-OLD at 6 months of follow-up. In all, 54.1% caregivers reported mild to moderate burden. Conclusion Focal seizure is the commonest seizure type of new onset seizure in the elderly. Hypertension is the commonest risk factor and cerebrovascular disease is the commonest etiology. New onset seizures in the elderly have a significant impact on both QOL and caregiver burden.

Acute infections of the central nervous system in children and adults: diagnosis and management.

Central nervous system infections are due to different microorganisms such as viruses, bacteria, mycobacteria, fungi, amoebas, and other parasites. The etiology depends on multiple risk factors, and it defines the infection location because some microorganisms prefer meninges, brain tissue, cerebellum, brain stem or spinal cord. The microorganisms induce diseases in the nervous system through direct invasion, neurotoxin production, and the triggered immune response. To determine the infection etiology, there are several diagnostic tests which may be conducted with cerebrospinal fluid, blood, respiratory and stool samples. These tests include but are not limited to direct microscopic examination of the sample, stains, cultures, antigenic tests, nucleic acid amplification tests, metagenomic next-generation sequencing, immunologic biomarker and neuroimaging, especially contrast-enhanced magnetic resonance imaging. The treatment may consist of specific antimicrobial treatment and supportive standard care. Since viruses have no specific antiviral treatment, antimicrobial treatment is mainly targeted at non-viral infections. This article will focus on diagnosis and treatment of acute acquired infections of the central nervous system beyond the neonatal period. The discussion defines the disease, provides the clinical presentation, explains the etiology and risk factors, and briefly mentions potential complications. This updated review aims to provide the reader with all the elements needed to adequately approach a patient with a central nervous system infection. Mycobacterium tuberculosis infection, Cryptococcus spp. infection and vaccines are not within the scope of this article.

Multidisciplinary Consideration for Managing Gingival Black Triangles in Aesthetic Dentistry: A Review

The importance of aesthetics in modern dentistry is paramount. Aesthetics has its different values and perceptions, which may be different from the eyes of the patient and those of the clinician [1]. It is dependent on the socio-economic status and the upbringing and mentality of each individual person. Open gingival embrasures or black triangle cause complex functional and aesthetic problems. Management of such problems requires careful evaluation of the underlying causes. In today’s aesthetic environment where both the dentist and the patient are aware of aesthetic value, the real challenge was to reconstruct this lost papilla and moreover to obtain stable and sustainable results. asure area, root angulations, interproximal contact position, triangular-shaped crowns and aging. Treatment of black triangles often requires an interdisciplinary approach, involving of periodontal; orthodontic and restorative treatment. In this review, the authors highlighted the important etiological factors that predispose to the occurrence of the black triangles. In addition to the common biological factors, dimensional changes of papilla during orthodontic alignment, the relevant consequences of periodontal disease treatment and iatrogenic treatment mishaps such as poor veneers and crowns are factors have also been discussed as factors that may lead to black triangles.

Polycaprolactone/gelatin-QAS/bioglass nanofibres accelerate diabetic chronic wound healing by improving dysfunction of fibroblasts

Worldwide, more than 25 % of patients with diabetes develop chronic diabetic wounds in their lifetime. Infection and dysfunctional fibroblasts represent two significant etiological factors contributing to impaired wound healing in patients with diabetes. It is therefore evident that the development of wound dressings with both anti-infective and DM fibroblast modulating functions has the potential for clinical applications. In this study, a PCL/gelatine-quaternary ammonium salts (QAS)/bioglass (BG) electrospun nanofibrous membrane was developed with physico-chemical and biological properties that not only meet the clinical requirements for wound dressings but also exhibit remarkable moisturising (water adsorption rate of 382.39 ± 4.36 %) and tear-resistance properties (a tear strength of ~5.5 MPa). The incorporation of QAS and BG has enhanced the biocompatibility and bioactivity of the nanofibres, while also imparting remarkable antimicrobial properties. The antibacterial efficacy of PGQ-BG against E. coli and S. aureus was found to be 92.8 ± 0.78 % and 99.3 ± 0.55 %, respectively. Moreover, it was demonstrated that PGQ-BG nanofibers exerted a promoting effect on the extracellular matrix (ECM) in dysfunctional fibroblasts and upregulated the expression level of α-smooth muscle actin (α-SMA), a marker of their differentiation to myofibroblasts in vitro and in vivo. Furthermore, the COL-III/COL-I ratio was significantly increased, indicating that PGQ-BG may also accelerate wound healing. The nanofibrous dressing reduced scar formation by increasing the COL-III/COL-I ratio. This is the first report of BG improving fibroblast dysfunction via COL-III and COL-I promotion in fibroblasts, both in vitro and in vivo. Therefore, this novel bioactive nanofibrous dressing represents an effective and safe therapeutic strategy for improving chronic wound healing in patients with diabetes.