Identification Of Cases Research Articles

Implementing SARS-CoV-2 Testing during a Large-Scale Sporting Event in Africa: Lessons Learned from the Africa Football Cup of Nations Tournament in Cameroon.

During the 33rd Africa Cup of Nations (AFCON) football tournament in Cameroon, organizers and health authorities required a negative SARS-CoV-2 test result <48 hours before entry and provided free SARS-CoV-2 testing and vaccination at stadium and fan zone entrances. We describe the outcomes and implementation of mandatory SARS-CoV-2 testing at fan zones during AFCON. All consenting fan zones attendees were administered an electronic questionnaire capturing exposure factors, COVID-19-like symptoms, and COVID-19 vaccination status, before being tested for SARS-CoV-2 using an antigen rapid diagnostic test (Ag-RDT). Participants testing positive were sampled for confirmatory real-time SARS-CoV-2 polymerase chain reaction (PCR) and sequencing for variant surveillance. The case detection rate was estimated using PCR-confirmed cases, and the challenges were summarized from staff discussions and project/study documentation. In total, 4,820 fan zone attendees (median [interquartile range] age 30 [24-38], 27.7% females) were tested for SARS-CoV-2, including 1,228 (25.5%) fully vaccinated. Of 4,820 participants, 148 (3.1%) had a positive Ag-RDT result, of whom 67 consented to PCR testing and 19 of 64 (29.7%) were confirmed PCR-positive. The case detection rate was 40.1 (95% CI: 24.2-62.7) per 10,000 attendees. The Omicron variant (B.1.1.529) was found in all 11 samples successfully sequenced. The implementation of mandatory SARS-CoV-2 Ag-RDT at fan zone entrances was challenged by high attendance volume just prior to matches, lobbying of economic stakeholders, and inconsistent quality assurance when using test kits. Despite the challenges encountered, implementing mandatory SARS-CoV-2 Ag-RDT at fan zones, was a unique opportunity for SARS-CoV-2 case identification and genomic surveillance.

Impact of the COVID-19 Pandemic on the Detection of Leprosy in Micro-Regions with a High Risk of Illness in Minas Gerais, Brazil

Background: Leprosy control remains challenging in Brazil and has been aggravated by the COVID-19 pandemic. Objective: To analyze the impact of the COVID-19 pandemic on the epidemiological scenario of leprosy through the detection rate of new cases, the risk of illness, and the hidden prevalence of leprosy according to high-risk micro-region in Minas Gerais, Brazil. Methods: An ecological study conducted in the health micro-regions of Minas Gerais, using data on new leprosy cases diagnosed between 2015 and 2023. The annual detection rate of new cases, the risk of illness index and the hidden prevalence of leprosy were evaluated. The time trend was evaluated by calculating the annual percentage change (APC) of the detection rate, based on segmented linear regression, considered significant when it showed p &lt; 0.05. Results: The state of Minas Gerais showed a significant negative annual increase between 2015 and 2020 (APC = −7.91; 95%CI −21.76–−1.72), and in 2020 it showed an inflection point, with an annual increase of 9.91 in the period from 2020 to 2023. When evaluating the hidden prevalence of leprosy in Minas Gerais, we observed a reduction in the estimates’ average from 2015–2019 (2.78) to 2020–2023 (2.00). The state as a whole showed an upward trend in the risk of illness, with the average index varying from 0.28 (medium risk) to 0.55 (high risk). Conclusions: The pandemic has had a considerable and heterogeneous impact on the detection of new cases, as well as on the risk of becoming ill and the hidden prevalence of leprosy, with repercussions for the control of the endemic in populations. There is a need to implement public health policies that prioritize the early identification of cases and ensure that vulnerable populations are monitored.

Development and validation of a claims-based algorithm to identify incidents and determine the progression phases of gastric cancer cases in Japan.

Although health insurance claims data can address questions that clinical trials cannot answer, the uncertainty of disease names and the absence of stage information hinder their use in gastric cancer (GC) research. This study aimed to develop and validate a claims-based algorithm to identify and determine the progression phases of incident GC cases in Japan. The gold standard for validation in this retrospective observational study was medical records of patients with incident GC who underwent specific treatments, defined by the claim codes associated with GC treatment. The algorithm was developed and refined using a cohort from two large tertiary care medical centers (April-September 2017 and April-September 2019) and subsequently validated using two independent cohorts: one from different periods (October 2017-March 2019 and October 2019-March 2021) and the other from a different institution (a community hospital). The algorithm identified incident cases based on a combination of the International Classification of Diseases, 10th Revision diagnosis codes for GC (C160-169), and claim codes for specific treatments, classifying them into endoscopic, surgical, and palliative groups. Positive predictive value (PPV), sensitivity of incident case identification, and diagnostic accuracy of progression phase determination were evaluated. The developed algorithm achieved PPVs of 90.0% (1119/1244) and 95.9% (94/98), sensitivities of 98.0% (1119/1142) and 98.9% (94/95) for incident case identification, with diagnostic accuracies of 94.1% (1053/1119) and 93.6% (88/94) for progression phase determination in the two validation cohorts, respectively. This validated claims-based algorithm could advance real-world GC research and assist in decision-making regarding GC treatment.

Hereditary breast and ovarian cancer genetic testing in unselected patients: example of private supplementation of public healthcare service.

In the Emilia-Romagna region (Northern Italy), the identification and management of women at familial/hereditary risk of breast and ovarian cancer is guided by a well-established regional protocol. Here we report the results of the experience of private supplementation of public healthcare service in offering the possibility to undergo BRCA1/2 testing and/or multigene panel testing (MGPT) within a well-defined pathway to women unfulfilling regional criteria. Out of 177 patients referred to our center who underwent BRCA1/2 testing, 175 tested negative while two (1.1%) resulted carriers of pathogenic variants in BRCA2; 69 patients also underwent MGPT, and in four cases (5.8%) a pathogenic variant were found (two in ATM and one in CHEK2 and RAD51C, respectively). Overall, this private supplementation of territorial public healthcare system has made it possible to confirm the validity of regional criteria for genetic testing access (concordance: 98.9%), but also to identify carriers of pathogenic variants of BRCA1/2 that would have escaped regional protocol, to support the effectiveness of MGPT for the identification of rare cases (not BRCA) at mild/high risk, and to provide reassurance to women who were found to be non-carriers of pathogenic variants, who may benefit from a more accurate assessment of their risk.

Participation in Tobacco Cessation Programs Among Medicaid Managed Care Enrollees in Florida.

Background/Objectives: Tobacco use remains a significant public health issue, particularly among individuals with low incomes, including Medicaid recipients who often face multiple barriers to quitting. This study aimed to identify barriers, from the perspective of Medicaid managed care organizations (MCOs), influencing Medicaid recipient participation in tobacco cessation programs. Methods: Focus group interviews were conducted with Florida Medicaid MCOs to elicit processes for case identification, outreach, referral, program participation, and incentives. Answers were synthesized into themes. Results: Medicaid recipients were primarily identified through nicotine dependency claim codes or Health Risk Assessments (HRAs). Individuals were referred to state and local community tobacco cessation programs through text messaging and outreach by MCO case managers. The MCOs identified the following as barriers: primary care physicians (PCPs) with limited knowledge about cessation programs and pharmacologic treatments for nicotine dependence, low availability of health coaches, long wait times for entry into cessation programs, weak coordination between MCOs and cessation programs, and insufficient incentives for individuals for program participation. Suggested strategies to overcome barriers were continuing medical education (CME) for PCPs about tobacco cessation programs and prescription therapies, increasing the training of health coaches, more investment in quitlines, increasing data sharing between MCOs and cessation programs, and increasing incentives for individuals. Conclusions: These findings highlight the importance of engaging MCOs in discussions about policy and program improvements, as their insights can drive meaningful changes in how tobacco cessation and other preventive health programs are structured and implemented. Targeted interventions are needed to enhance tobacco cessation program participation among Medicaid recipients.

Breast Neuroendocrine Carcinoma Discovered by Lymph Node and Osteomedullary Metastasis: A Case Report

This case highlights a rare presentation of small cell mammary neuroendocrine carcinoma in a young woman, with metastatic spread to the spinal cord. Such a presentation is exceptionally uncommon, particularly in this demographic, and underscores the diagnostic challenges associated with neuroendocrine tumors outside typical locations. Reporting this case adds to the limited literature on mammary neuroendocrine carcinoma with spinal metastasis and may guide early identification in similar cases. We report A 20-year-old female patient 3 with persistent lower back pain over three months. Clinical examination revealed cervical lymphadenopathy and bilateral breast masses. Magnetic resonance imaging (MRI) identified a spinal tumor infiltration. A biopsy of the cervical lymph nodes, followed by immunohistochemical analysis, confirmed the diagnosis of small cell mammary neuroendocrine carcinoma. Chemotherapy was chosen as the primary therapeutic approach, given the tumor’s aggressiveness and advanced stage at diagnosis. This case underscores the importance of considering neuroendocrine carcinoma as a differential diagnosis for young patients presenting with atypical tumor localizations, such as bilateral breast masses and spinal metastasis. The case highlights the necessity of a multidisciplinary approach in diagnosing and managing rare tumors and demonstrates the potential impact of prompt recognition and treatment to improve outcomes.

Post‐term births as a risk factor for small for gestational age births and infant mortality in Brazil, Mexico, and Palestinian refugees: An analysis of electronic birth records

AbstractBackgroundPost‐term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High‐income countries have responded to this risk by widely adopting labour induction protocols in late‐term, but many low‐ and middle‐income countries have not. However, understanding underlying mechanisms linking post‐term births to adverse newborn and infant outcomes remains limited.ObjectiveTo investigate the (a) prevalence of post‐term, (b) the risk factors associated with post‐term (c) the association between post‐term births and the risk of small‐for‐gestational‐age (SGA) neonates and of infant mortality in middle‐income settings.MethodsWe used existing electronic datasets from the general population of Brazil, Mexico, and Palestinian refugees. Regression models were used to explore the associations between post‐term birth and SGA and infant mortality.ResultsWe analysed 21,335,033 live births in Brazil (2011–2018), 23,416,126 in Mexico (2008–2019), and 966,102 in Palestinian refugees (2010–2020) (N = 45,717,261). Post‐term deliveries accounted for 3.1% of births in Brazil, 1.2% in Mexico, and 2.1% in Palestinian refugees. Post‐term births had approximately three times the risk of resulting in SGA neonates compared to term births. Additionally, post‐term neonates exhibited a 15% to 40% increased risk of infant mortality compared to term infants. Notably, post‐term SGA neonates faced a significantly increased risk of infant mortality compared to term appropriate for gestational age neonates.ConclusionsThese findings emphasise the critical significance of implementing induction strategies to prevent post‐term pregnancies and mitigate the associated risks of SGA neonates and subsequent infant mortality. Moreover, the study highlights the importance of accurately determining gestational age and using INTERGROWTH‐21st charts to improve the identification of SGA cases, enabling targeted interventions. This is especially relevant because post‐term SGA neonates may not exhibit low birthweight (a commonly used risk marker) and, therefore, may miss out on required specialised attention.

Case Ascertainment in Pediatric Heart Failure Using International Classification of Disease Clinical Modification (ICD-CM) Codes.

Most epidemiological studies in pediatric heart failure (HF) use administrative database sources, defining patient cohorts by presence of a single HF ICD code. However, the ability of ICD codes to identify true HF patients is unknown in pediatrics.Here we describe the accuracy of HF ICD-10-CM code search algorithms, in identifying pediatric patients with HF from electronic data sources. Based on the adult HF literature, search algorithms were designed to incorporate HF ICD codes, imaging, and medications. Sensitivity, specificity, positive and negative predictive value and accuracy of the algorithms were tested among children in an advanced HF clinic ("Clinic cohort"). Top-performing algorithms were then tested in a large-scale regional electronic data warehouse (EDW), 01/2017 to 01/2020, generating the "EDW Cohort". False positive cases were identified and characterized by chart review. Within the Clinic Cohort, 78/378 patients (21%) had gold standard HF diagnoses. A search algorithm with one HF ICD coded visit was more sensitive but less specific than > 1 HF ICD coded visit, (sensitivity 94% and specificity 89% versus 69% and 97%, respectively). Correspondingly, > 1 ICD coded visit had a higher PPV than one ICD coded visit; 84% vs. 69%. Accuracy was similar (90% vs 91%). Presence of 1 HF ICD code combined with HF medication had high sensitivity, specificity, PPV, NPV and accuracy, all higher than the single ICD code algorithm. The "1 HF coded visit + any medication" algorithm resulted in highest accuracy (93%). Top-performing algorithms were tested in the EDW: the algorithm with > 1 HF ICD coded visit, and the algorithm with one HF ICD coded visit combined with HF medication. In the EDW Cohort, 133/248 (53.6%) patients had gold standard HF diagnoses though 115/248 (46.3%) were false positive cases; 41% of those had pulmonary over-circulation from congenital heart disease. Excluding children < 30days old and those with a history of an isolated VSD repair, complete AVSD repair, or PDA closure further reduced the proportion of false positives to 50/248 (20%). A search algorithm using a single HF ICD code can have acceptable sensitivity, specificity, PPV, NPV and accuracy in identifying children with HF from within electronic medical records. Similar to adult HF literature, specificity improves by including HF medication. When applied to large data sources, however, the search algorithms result in a high proportion of patients with pulmonary overcirculation related to congenital heart disease. To narrow the population to those with myocardial dysfunction, case identification may require use of ICD codes with linked of administrative, surgical, and/or imaging databases.

Changes in the prognosis of CADASIL over time: a 23-year study in 555 individuals

BackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of stroke and is associated with early-onset stroke and dementia. Whether its clinical phenotype...

Development of the post-traumatic stress disorder assessment scale for emergency services

This paper describes the development and validation of the Post-Traumatic Stress Disorder Assessment Scale for Emergency Services (PASES). The PASES was developed to address the needs of Australia’s first National Mental Health and Wellbeing Study of Police and Emergency Services, Answering the Call (AtC) which covered Police, Ambulance, Fire and Rescue and State Emergency Services personnel. PASES offers several advantages for use in the emergency services sector over other Post-Traumatic Stress Disorder (PTSD) screening scales, including assessment of functional impairment, a dimensional measure of severity which includes identification of sub-threshold cases experiencing distress and impairment, and allowing for experience of cumulative trauma. Analysis of Composite International Diagnostic Interview (CIDI) data from a large national sample identified PTSD symptoms that usually co-occur allowing streamlining of the scale with minimal information loss. In a large sample, PASES had high specificity and adequate sensitivity in comparison to self-reported PTSD diagnosis. Data from AtC supported there being a strong dimensional gradient in distress and associated harms, including suicidal behaviors, across the levels of severity of the PASES. In a subsample of 191 fire sector employees who completed both PASES and PCL-5, both scales had equivalent discrimination compared with self-reported diagnosis of PTSD by a mental health professional. The paper also presents population data for Australian volunteer and employed emergency services personnel collected in AtC.

Mapping gaps and exploring impairment and disability prevalence in South Asian (SAARC) countries: a scoping review

Despite the considerable health and economic burden of disability in the South Asian (SA) region, there is limited evidence of impairments and disabilities prevalence and the need for Assistive Technologies (ATs). This scoping review aims to synthesise the evidence of the impairments and disabilities in SA countries. This review followed Arksey and O’Malley’s methodological framework. EBSCOhost, EMBASE, PubMed, and Web of Science databases were searched for original research articles from SA countries. In this study, impairment and disability refer to functional limitations restricting individuals from performing activities, including visual, hearing, speaking, cognitive, mobility, and self-care difficulties. The review included full-text, English-language articles addressing any impairment and disability, without restrictions on publication date. This review identified 105 articles distributed over the six impairment and disability domains: visual, hearing, mobility, self-care, speaking, and cognitive. Most evidence originated from India (50.5%) and focused on visual impairments (53.3%). The review identified that heterogeneity in methodologies, case identification definitions, and study settings contributed to variations in prevalence estimation and restricted the comparability within and across countries. Besides, the uneven distribution of studies across countries suggests varying inclinations of countries toward specific impairment and disability domains. The review identified variations in prevalence due to differences in methodologies, definitions, and contexts. The review also identified the uneven distribution of studies, limited evidence on ATs, reliance on self-reported data, and lack of nationally representative research. Future research should use standardised case identification and evidence-based approaches to enhance comparability and minimise response biases.

Operationalisation of post-COVID condition case definition in a comprehensive research protocol.

Post-COVID-19 condition (PCC) is a prevalent and high-burden sequela of SARS-CoV-2 infection. Because of the complexity of its manifestations, PCC case definition currently lacks standardisation and reproducibility. We aimed to devise a simple screening tool to boost reproducibility and comparability of PCC case definition across PCC studies, and to provide a framework in which to reliably identify suspected PCC cases. We also developed a comprehensive assessment protocol based on the most frequently reported PCC characteristics. Within a European multi-centre study and based on the conclusions of a previous systematic review, we devised a checklist to assess the presence of PCC-associated symptoms and their temporal relationship with COVID-19. The checklist was developed to include three symptom cores (cognitive, psychiatric, and general). For each symptom, onset is assessed within 3 months after COVID-19 resolution and persistence for at least 2 months. Any symptom fulfilling this criterion is sufficient to prompt suspicion of PCC. At least one symptom is required in the cognitive or psychiatric domains to suspect PCC with neuropsychiatric involvement. Our protocol features an extensive neuropsychological evaluation and self-administered scales for mood, anxiety, stress-related symptoms, sleep disorders, quality of life, disability, mental health, and personality traits; scales for quantitative assessment of fatigue and headache are also included. Consistent identification of PCC cases is crucial to correctly include patients in research and clinical studies. We propose a simple, reproducible, and flexible screening tool and a proposal for a comprehensive assessment that could be employed to enhance standardisation and comparability.

HPB SO06 - An advanced clinical practitioner (ACP) led pancreatic cyst surveillance programme

Abstract Background The prevalence of pancreatic cysts (PCs), including intraductal papillary mucous neoplasms (IPMNs), has increased substantially over recent decades. This rising prevalence is due largely to the increasing volume and quality of medical imaging technology. Although PC's are often an incidental finding in asymptomatic individuals, a small number do harbour a certain malignant potential and thus raise warranted concern. The challenge therefore is identifying the high-risk lesions for early resection through robust, guideline-driven surveillance. To ensure a consistent and evidence-based approach to PC surveillance, our trust has adopted a dedicated surveillance programme led by an Advanced Clinical Practitioner (ACP) in gastroenterology. Method A PC surveillance clinic was designed and delivered from April 2023. The service underwent a formal inauguration and was promoted at the regional HPB MDT. All patients receive a standardised approach to surveillance in-line with the current international guidelines or regional MDT recommendation. Surveillance diagnostics are arranged by the ACP and patients are updated with regard to their results and next steps during a telephone or face-to-face consultation. A robust database was designed to capture relevant patient details and serve as a future research aid. Results 144 referrals have been received (04/23-04/24). 134 are undergoing surveillance, with discontinuation due to frailty, patient choice, diagnosis of an inflammatory cyst or relocation in 10 cases. Most PCs under surveillance are side-branch IPMNs (70.9%). Malignant transformation has not yet been observed, however 18 cases display worrisome features and 3 have high-risk stigmata. These are undergoing intensive surveillance or awaiting MDT discussion. 93% of surveyed patients (16) report a greater sense of involvement in their PC surveillance and a greater awareness of their surveillance protocol (93%). Referrer feedback (7) has been positive and staff are satisfied with this service (100%). Conclusion Robust surveillance of patients with PC will likely improve early detection and prognosis of pancreatic cancer by enabling early identification of resectable cases. A centralised service that adopts a single agreed guideline will reduce variation in the management of these cysts, ensure these complex lesions are under specialist observation and offer a single point of contact which will improve retainment and follow-up of these patients. It is intended that synchronous data collection will serve to generate a comprehensive repository of information relating to PC. This databases will aid future research into this evolving field and steer future guideline development.

Factors affecting treatment delays among malaria patients presenting at health facilities in Guinea, 2022–2023

BackgroundEarly identification and management of cases are key for controlling and eliminating malaria. This study aimed to assess the factors associated with the delay malaria treatment in Guinea.MethodsCross-sectional study was conducted at 60 health facilities in eight administrative regions from December 2022 to March 2023. Patients with a diagnosis of malaria through either microscopy or a rapid diagnostic test (RDT), were interviewed using a standardized questionnaire. Treatment delays were defined as seeking care 48 hours after the onset of symptoms. Logistic regression was performed to assess factors associated with treatment delay. Adjusted odds ratio (OR) and confidence interval (CI) were used to explain the associated factors.Results3,300 malaria patients were included and the findings showed a median time of symptoms onset and access of malaria treatment was 3.04 days. Alarmingly, only 800 (24.24%) of all cases sought and received treatment within 48 hours of symptom onset. The multivariate logistic regression indicated that children under 5 years of age who attempted self-medication for fever were 4.32 times more likely to experience a delay in treatment than those who sought immediate medical care in health facilities (OR:4.32, 95% CI: 2.96–6.36). Children whose parents had no formal education were 3.05 times more likely to experience a delay in treatment (OR:3.05, 95% CI: 1.66–5.60). Moreover, when the disease was considered non-severe the first time by caregivers, OR = 1.71 (95% CI: 1.26–2.33). For those 5 years old and above, using university hospital OR = 4.01, (95% CI: 2.01–8.44), living in Forest Guinea OR = 3.14, (95% CI 1.93–5.10) and Middle Guinea OR = 1.46 (95% CI: 1.09–1.95) were more likely to experience delay treatment.ConclusionsThe proportion of malaria patients with treatment within 48 is low, significantly falling short of the national targets. This substantial delay in treatment was attributed to factors such the lack of formal education, self-medication practices, and failure to recognize the illness severity. These findings underscore the urgent need for NMCP to enhance awareness regarding the importance of early presentation at health facilities, with targeted interventions.

A EXIGÊNCIA DE POLÍTICAS PÚBLICAS PARA A CONTENÇÃO DA LITIGÂNCIA PREDATÓRIA

This article aims to analyze the phenomenon of predatory litigation, which consists of the abusive use of the Judiciary with the intention of causing financial harm to third parties. Initially, the history of predatory litigation in the United States is presented, with the creation of antitrust laws and jurisprudence on the subject. Next, the metaprocedural effects of predatory litigation are addressed, which go beyond the judicial decision and may have strategic motivations. The article also analyzes the perception of the phenomenon by the Brazilian Judiciary, with the identification of emblematic cases and the adoption of measures to curb this practice. Finally, public policies are proposed to address predatory litigation, with an emphasis on awareness, prevention, institutional strengthening, and the promotion of alternative dispute resolution methods. The goal is to contribute to the construction of a more efficient and fair justice system, capable of curbing the abusive use of the Judiciary.

Shadow Testing in Autonomous Vehicles : A Novel Approach to Validating Full Self-Driving AI Systems

As autonomous vehicles progress towards widespread deployment, ensuring the reliability and safety of Full Self-Driving (FSD) AI systems remains a critical challenge. This article presents a comprehensive analysis of shadow testing, an innovative approach to validating new FSD AI models in real-world conditions without compromising user safety. We examine the methodology of deploying new AI models in "shadow mode," where they process live sensory data alongside the operational system but do not control the vehicle. This approach enables the collection of valuable performance metrics and the identification of edge cases while mitigating risks associated with direct deployment. Our study demonstrates how shadow testing facilitates a continuous feedback loop for iterative improvement, enhancing model reliability through data-driven refinement. We further explore the challenges of implementing shadow testing at scale, including data processing requirements and ethical considerations. Our findings suggest that shadow testing not only accelerates the development of robust FSD systems but also plays a crucial role in building public trust in autonomous vehicle technology. This article contributes to the growing body of knowledge on AI safety validation techniques and provides insights for standardizing testing protocols in the autonomous vehicle industry.

Identification of atypical pediatric diabetes mellitus cases using electronic medical records

IntroductionThere are no established methods to identify children with atypical diabetes for further study. We aimed to develop strategies to systematically ascertain cases of atypical pediatric diabetes using electronic medical...

Zirconia in fixed prosthodontics: a review ofthe literature.

The purpose of this narrative review is to organize information and knowledge about the properties of the clinical evidence of zirconia-applied dental restorations and to provide relevant information to establish application methods to obtain long-term clinical prognosis of zirconia-applied dental prostheses. From PubMed and manual searches, found "zirconia," "crown," "survival," and "success" keywords were searched. Case reports, case series, reviews, abstracts, in vitro studies, and observational studies were excluded. Additionally, implant superstructures not supported by the periodontal ligament and partially covered crowns were excluded. A total of 42 studies were identified. According to the studies in this review, the most common complication of porcelain-layered zirconia restorations is porcelain fracture, but the long-term prognosis is stable. However, complications of monolithic zirconia restorations include crown fractures and fractures of the abutment tooth and root, and long-term clinical evidence is not available yet. Additionally, bruxism can be a complication factor with both types of restorations, so it is important to carefully examine the oral habits, including bruxism, before treatment. Therefore, the success of zirconia-based restorations in clinical practice requires a careful approach in addition to accurate knowledge of the zirconia material and identification of applicable cases.

Indian Council of Medical Research (ICMR)-Sickle Cell Disease (SCD) Stigma Scale for India (ISSSI): A Protocol for Scale Development.

Sickle cell disease (SCD) is a genetic blood disorder presenting a substantial public health challenge. India, holding the second-highest prevalence globally, exhibits diverse clinical manifestations. The recently launched National SCD Elimination Mission (NSEM) in India has contributed to an increased identification of cases. The national program should extend its services beyond screening and clinical management. The outcome of the disease is influenced by a multitude of factors impacting healthcare utilization, with stigma emerging as a major influencer. Addressing stigma at the right time is crucial to comprehensive disease care. Understanding and quantifying the type and level of stigma in the ecosystem are fundamental steps toward tackling this pressing issue, necessitating the development of a scale. The existing three scales developed and utilized in African and American contexts may not be suitable for the Indian SCD community due to phenotypic, socio-cultural, and contextual variations. Therefore, developing, modifying, and creating a locally applicable scale is imperative. This protocol paper outlines the process of developing, refining, and evaluating the Indian Council of Medical Research (ICMR)-SCD Stigma Scale for India (ISSSI), which will be developed by Indian researchers led by the ICMR.

Periodontal diseases in Africa.

Periodontal diseases, a group of complex conditions marked by an excessive immune response and periodontal tissue destruction, are a global health concern. Since 1990, the incidence of these diseases has doubled, with Western sub-Saharan Africa experiencing the highest burden. Accurate diagnosis and case identification are crucial for understanding the etiology, features of disease, research, treatment and prevention. Modern perspectives on periodontal disease classification are based on commonality among those affected. However, current literature is often plagued by methodological inconsistencies and focused on disease mechanisms in European populations. Health inequalities in low- and middle-income countries (LMICs) are exacerbated by these challenges, with sub-Saharan Africa, and Nigeria specifically, facing unique difficulties such as clinical personnel shortages and limited research infrastructure. This review explored disparities in periodontal disease research, care and outcomes in African populations. We highlighted these disparities and identified the factors contributing to inequities in periodontal health outcomes. We further demonstrated the critical need for inclusive and equitable healthcare and research practices tailored to the unique challenges faced by diverse populations and regions with limited resources. Addressing these disparities is essential for ensuring that advancements in healthcare are accessible to all, thereby improving global oral health and general health.