Common Etiological Factor Research Articles

STUDY ON ETIOLOGICAL PROFILE OF PATIENTS WITH PAPILLOEDEMA

Aims and objectives : To study the aetiological pattern in Papilledema,To study the involvement of 6th cranial Nerve in Papilledema, To study the visual acuity pattern in papilledema,To study the visual field pattern in papilledema. Materials and Methods: This observational study was conducted at andhra Medical College ,vizag for a period of 4 months from feb 2022 to may 2022 .After taking informed consent of 15 Patients with papilledema who were referred from various departments in KGH were examined thoroughly as per proforma. We included patients with papilledema on ophthalmoscopic examination admitted in department of medicine . We excluded patients with optic disc swelling due to other cause that do not involve raised intracranial pressure, and Patient with head injury.All subjects were subjected to routine and special investigation to ascertain the Etiological Proportion of papilledema.In this study patients included on the basis of fundus examination done by slit lamp examination with 78D, and graded according to frisen scale of papilledema . Patients who had papilledema undergoes to evaluation of history, general examination and investigational work up. Then all patient had neuroimaging to detect intracranial pathology and lumbar puncture done in those patient who have no contraindication. Results:Among 15 cases majority were Females(60%),majorly are of 3rd & 4th decade,vision improving to 6/6 with correction (90%),mri showed space occupying lesions(53.3%),associated with 6th nerve palsy in (44.4%),visual fields showed enlarged blind spot in most of the cases(47%). Conclusion:in our study most common etiological factor is space occupying lesion.not all papilledema are associated with 6th nerve palsy.not all papilledemas have visual field defects.

Tracheostomy in Non-malignant Disorders

Background: Tracheostomy is a surgical procedure, often a life saving measure in a variety of clinical conditions. It is one of the commonest procedures carried out on the critically ill patient. The most common causes of non-malignant airway obstruction are head and severe facial trauma, cerebrovascular accident, coma, respiratory burn and presence of foreign bodies in airway etc. Tracheostomy is an increasingly utilised adjunct in the ICU management of patients. Effective tracheostomy management involved the multi-professional team in a coordinated approach.
 Objectives: To study the indications of tracheostomy in non-malignant disorders.
 Study design: Cross-sectional study.
 Study setting and period: Department of Otolaryngorhinology and Head- Neck surgery (Unit- 1,2,3), General Surgery, ICU, Casualty, Neurosurgery, Thoracic surgery, Burn & Plastic Surgery and relevant OPD in Dhaka Medical College Hospitalfrom6th September 2015 to 5th March 2016.
 Methods: A hospital based cross-sectional study. Fifty patients admitted to hospital, underwent tracheostomy for non-malignant factors. Purposive samplings technique was used. Detail demographic data were collected from the informant and recorded in structured case record form. Clinical examination and relevant investigation were done meticulously. All collected questionnaire checked very carefully to identify the error in the data. Data processing work consist of registration schedules, editing computerization, preparation of dummy table, analyzing and matching of data.
 Result: A total of 50 patients of non-malignant pathology causing airway patency loss in different ward unit of DMCH were selected. In this study, maximum numbers of patients (36%) were between 51-70 years age groups with mean age was 47.23±11.57 years. It was observed that, frequency of non-malignant aetiology for tracheostomy gradually increases with age. Study show that, 51-70 years was most frequent age group (36%). Out of 50 cases 82% were male. Present study show that socioeconomically majority patients were poor class (52%), highest percentage of patient comprised of day labourer (30%). Head trauma (12%) and cerebrovascular accidents (9%) were the most common etiological factor trauma was the major aetilogical group (50%),followed by, central drive problems or neurological disease (38%) and elective tracheostomy was done.
 Conclusion: Head and facial trauma, cerebrovascular accident, coma, respiratory burn and presence of foreign bodies etc. are common aetilogical factors. It was found that tracheostomy is safer alternative to intubation when a prolonged artificial airway is required.
 Bangladesh J Otorhinolaryngol 2022; 28(2): 157-164

A COMPREHENSIVE STUDY OF CLINICAL PROFILE, RISK FACTORS AND TREATMENT OUT COME OF PERIPHERAL ARTERIAL DISEASES OF LOWER EXTREMITIES

Objectives: To study the pattern of clinical presentation, aetiology, various investigations for diagnosis and management of Peripheral arterial occlusive disease. This is a cross-sectional s Materials And Methods: tudy including 50 patients who presented to OPD at Government General Hospital, Anantapur, with Peripheral arterial occlusive disease. patients above the age of 18 years with symptoms of rest pain, claudication pain, ulceration and gangrene with evidence of lower limb arterial occlusive disease on doppler are included in this study. Patients less than 18 years of age and PAD of upper extremities, patients with history of trauma of lower extremities and pain due to musculoskeletal or neurological origin are excluded. The results of the Statistical Analysis: study are expressed in terms of proportion. In this study the most common etiological factor contributing for Peripheral arterial o Results: cclusive disease is atherosclerosis (76%) followed by thromboangiitis obliterans (24%). This disease has male preponderance and the most common age group affected is 41 years and above. The most common mode of presentation is rest pain and 50% of patients presented with gangrene affecting foot and lower 1/3rd of leg. The most common co-morbid condition associated with Peripheral arterial occlusive disease in this study is diabetes mellitus. Tobacco smoking is the most common addiction associated with Peripheral arterial occlusive disease. 45% patients with atherosclerosis showed involvement of infra-popliteal site. Almost all patients required surgical intervention due to the late presentation at tertiary care center. 66% of patients in this study required amputation. None of the patient died following amputation in this study.The cardiac evaluation showed abnormality in almost 20% of the study group. This emphasises the need for cardiac evaluation in all cases of peripheral arterial disease and this condition is called atherosclerosis. peripheral arterial disease is due Conclusion: to atherosclerosis in most of cases with male preponderance after 41 years and above with gangrene as the most common clinical presentation. Prompt surgical intervention in the form of amputation, reduced mortality rate.

VISUAL HANDICAP CERTIFICATES: A TOOL TO EVALUATE THE CAUSES FOR PERMANENT VISUAL IMPAIRMENT IN KURNOOL DISTRICT

Aim: To analyze the causes of visual impairment amongst the patients coming for the visual handicap certificate and its application in eye health planning to prevent the blindness. Methods and Materials: A retrospective data analysis of medical records of 1020 people who had applied for the visual handicap certification. Examination was done by the ophthalmologists appointed for the handicap board. BCVA < 20/60 to 20/120 in better eye was included in visual impairment Cat I (40%) and BCVA 20/200 or less is blindness category II to IV (75%to100%). Results: Majority of them belonged to age group of 16 year to 45 years of age, 264 cases got rejected, 530 individuals had mild visual Impairment (< 40%), in 136 individualÂ’s moderate visual impairment (40%) was found in 90 individuals had sever visual impairment to blindness. Overall Optic Atrophy was the most common cause followed by Retinitis Pigmentosa, followed by macular pathology followed by corneal opacity followed by phthisis bulbi followed by amblyopia. Conclusion: Visual handicap registers are useful for the rehabilitation of visually impaired individuals and to assess the pattern or causes of blindness in particular area. The most common etiological factors causing visual impairment in our study are preventable so we propose the empowerment of the school health system and general health delivery system.

The Rate of Locomotor System Disability in Patients Undergoing Electroneuromyography

Aim: It was aimed to evaluate the characteristics of the patients who were referred to our electroneuromiyography (ENMG) Laboratory to evaluate the rate of locomotor system disability from the Disabled Health Board (DMB). Materials and Methods: Patients aged 18 years and over who applied to our hospital's DMB in the last three years (01.01.2019-31.12.2021) and were referred to the ENMG Laboratory to determine the disability rates related to the locomotor system were included. With the retrospective analysis, demographic characteristics of the patients, ambulatory levels, etiological factors, reasons for applying to the ENMG Laboratory, and diagnoses in ENMG reports were noted. Results: Files of 1306 patients were reviewed, ENMG was performed in 139 (10.64%). The mean age was 45.34±12.2 years. One-hundred and eleven (79.9%) patients were male and 28 (20.21%) were female. Eighteen (12.9%) of the patients needed an assistive walking device. The most common etiological factors in locomotor system disability was disc herniation in 24 (17.2%) patients. The most common preliminary diagnosis was peripheral nerve injury in 67 (48.2%) patients. Peripheral nerve injury was the most frequently reported pathology in ENMG reports with 52 (37.4%) patients. While the ENMG report of 26 (18.7%) patients was normal; entrapment neuropathy was found in 14 (10.1%) patients, polyneuropathy in 10 (7.2%) patients, plexopathy in 8 (5.8%) patients, and cranial neuropathy in 1 (0.7%) patient. Conclusion: Peripheral nerve injuries are the most common pathology in both preliminary diagnosis and ENMG reports. ENMG provides information such as the location and the severity of the lesion, so electrodiagnostic tests are very important in the evaluation of locomotor system disability.

Urinary stasis in a transplanted kidney: 20 years of experience of one transplant center

Introduction/Objective. Urinary stasis in a transplanted kidney occurs due to ureteral obstruction caused by intrinsic or extrinsic etiological factors. The aim of this study was to determine the prevalence, time of occurrence, and etiopathogenetic factors of urinary stasis and their distribution according to the type of kidney donor. And to analyze the success of different types of surgical and conservative treatment. Methods. The retrospective-prospective randomized study included 580 patients transplanted in the Transplant Center, Clinic of Urology, University Clinical Center of Serbia, for a period of 20 years. After diagnosing urinary stasis, minimally invasive or open surgical interventions were performed, while for one group of patients the definitive treatment was non-surgical with observation and active monitoring. The main control parameters during non-surgical treatment were the diameter of pyelon, serum creatinine values, and urine culture findings. Results. Urinary stasis was found in 15% of transplanted patients. The largest number of transplanted patients had early urinary stasis, within three months of transplantation (68%). The most common etiological factors of urinary stasis were intrinsic factors (66%), which were significantly more frequent in transplant patients from a living donor. Non-surgical treatment with observation and active monitoring was successfully performed in 22% of the patients. Conclusion. The largest number of transplanted patients with urinary stasis has been successfully treated surgically, most often with open surgery. Surgical correction is advised in cases of pronounced dilatation of the canalicular system with a tendency to increase, in progressive decrease in renal function, and recurrent complicated urinary infections refractory to antibiotic therapy.

Teduglutide therapy in a child with short bowel syndrome

Introduction. Short bowel syndrome (SBS) in children is a rare disease. One of the most common etiological factors for the development of SBS in children is atresia of the small intestine. After surgical correction of the congenital anomaly, the remaining intestine attempts to increase absorption to restore homeostasis, and the process of intestinal adaptation begins. This process of adaptation can be assisted with analogues of endogenous growth factors of the intestine, such as teduglutide. Case outline. This report presents ? girl, aged two years and eight months, who had an estimated 20 cm of small intestine after surgical correction of congenital small bowel atresia and clinical signs of SBS. She was repeatedly hospitalized due to frequent need for parenteral correction of fluid, electrolyte, and nutrient imbalances. Stagnation in body weight and slow growth in body height were accompanied by weakened gross motor strength and slowed psychophysical development. After exploit conservative treatment measures, stimulation of intestinal adaptation was initiated with the drug teduglutide. After six months of drug therapy, progress was observed in body parameters, as well as an increase in intelligence quotient and motor abilities. Conclusion. SBS is a challenging entity for every clinician, and its previous therapy has mainly consisted of parenteral substitution of nutrients, fluids, and electrolytes. Surgical treatment carries the risk of loss of the remaining bowel and lifelong immunosuppression. The pharmacological possibilities of promoting intestinal adaptation using drugs such as teduglutide represent a light at the end of the tunnel for patients with SBS.

Smokeless tobacco: a ticking time bomb for Pakistan

Oral cancers are one of the most prevalent cancers worldwide with almost 300,000 cases reported annually1. In Pakistan, it is the leading type of cancer in men and women after breast cancer. Each year around 16,000 new cases of oral cancers are documented with 5500 cases resulting in death2. There are multiple etiological factors for oral cancers among which the use of smokeless tobacco (SLT) is at the top of the list. SLT is available in different consumable forms such as chewable tobacco, betel leaf, snuff (naswar), Betelnut, etc., which contain a number of carcinogenic substances3. Studies have revealed that naswar is the most common etiological factor of oral cancers among the Pakistani population as compared to the other forms of SLT3. The basic constituents of naswar are slaked lime, powdered tobacco, and indigo which contain more potent carcinogens such as unionized nicotine and tobacco-specific N-nitrosamines, that are specifically harmful to the oral cavity4. It can be used through different routes either inhaled nasally or by placing inside the mouth under the tongue. The nicotine is absorbed into the oral mucosa which is further aided by the increased pH of the mouth by slaked lime5. It has been observed historically that the use of SLT products is very commonly acceptable in Pakistani culture3. The sale and production of naswar are not well regulated and it is being sold by different vendors at cheaper prices and in different package sizes with no such instructions and health warnings written on it1,2. Moreover, some scientific data implicates it as replacement therapy for tobacco smoke cessation as it is a cheaper nicotine substitute1. In 2005, Pakistan formalized the WHO “Framework Convention on Tobacco Control (FCTC),” which addresses the details of the regulation and control of tobacco and SLT products by regulating its price, taxation, packaging, labeling, advertisement, promotion, and sponsorship5. In the last few years, Pakistan has made significant progress in smoking cessation policies but regulation of STL production and taxing is still lagging5,6. A case-control study, conducted in Khyber Pakhtunkhwa, Pakistan, revealed that 68% (men) and 38% (women) of oral cancer patients in Pakistan are due to naswar use. It was also shown that those who used naswar ever in their lifetime have 20 times more risk to develop oral cancers compared with the nonusers of naswar1. Thus, the increasing incidence of oral cancers with the relative use of naswar sets a ground basis for the implementation of strict policies regarding the manufacture and sales of SLT. Studies have provided shreds of evidence that there is a marked decrease in tobacco product use among young people by applying a ban on their promotion and advertisement. Health warnings and relevant constituents written on packages can also be an important tool for minimizing SLT use6. Sticking firmly to the FCTC protocols of smokeless tobacco use is the dire need of time. Furthermore, awareness regarding the harmful effects of STL use should prevail on urban and rural levels as there is a great lack of knowledge among the local population. Ethical approval None. Sources of funding None. Author contribution S.F., O.A.S., G.S., and A.K.: wrote the manuscript. O.A.S. and S.A.: review editing, formatting, and referencing. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) N/A. Guarantor Omer Ahmed Shaikh. Financial Disclosure The author(s) received no financial support for the research, authorship, and/or publication of this article.

Etiology and Complications of Deep Neck Space Infections: A Hospital Based Retrospective Study.

Infections of the deep spaces of the neck often present a true clinical challenge to a Head and Neck surgeon which may rapidly spread due to the various connections between the spaces resulting in morbidity and mortality. This study aims to obtain knowledge about various DNSI's and their predisposing factors.. It was a hospital based retrospective cross-sectional study done in Goa Medical College, India. A total of 300 patients who presented with DNSI's over the past 7years were studied. Simple proportions and percentages were calculated and Chi-square test was used to study associations. A total of 300 patients were evaluated and male preponderance was seen. Most of the patients were seen belonging to the pediatric age group (26%). Infections of dental origin (45.67%) were the most common etiological factor associated with poor oral hygiene and tobacco chewing (12.67%). Major comorbidities were anemia (34%) and diabetes (19.3%) which were directly related to the complications. The most common complication was airway compromise (14.66%) which was treated by tracheostomy. DNSI should be treated like a medical as well as a surgical emergency which can be life-threatening especially in diabetics and elderly who are immunocompromised and need special attention. Odontogenic infections associated with poor oral hygiene and tobacco chewing could be prevented by educating the population about oral hygiene.

Assessment of distribution of clinically undetectable mucogingival junction in mandibular anterior region: A single-institutional study

Introduction: The mucogingival junction is considered one of the vital anatomic structures that mark the apical termination of the attached gingiva. However, due to various pathologies and conditions, it can be undetectable. This study aimed to assess the distribution of patients having teeth without clinically detectable mucogingival junction in mandibular anteriors. Various etiologies leading to clinically undetectable mucogingival junction were also identified. Methods: This cross-sectional study involved 312 patients who visited the department of Periodontics of Gandaki Medical College Teaching Hospital and Research Center, Pokhara from July 26 to November 26, 2022. The visual method, rolling probe method, tension test and histochemical staining were used to detect the mucogingival junction. To ascertain the relationship between age and gender with the distribution of data, descriptive analysis and the Pearson Chi-square test was used. A p-value <0.05 was considered statistically significant. Results: The majority of the patients 242(77.6%), had clinically detectable mucogingival junction, whereas the remaining 70(22.4%) didn’t show its absence. Gingival recession, keratosis, deep pockets, and aberrant frenal attachment were all common etiologic factors for clinically undetectable mucogingival junction. Statistically significant number of male patients from age group above 45 years presented with clinically undetectable mucogingival junction. Conclusions: Nearly one-third of the study population presented with clinically undetectable mucogingival junction, which provides baseline data to determine the periodontal health of the study population and can represent as one of the significant diagnostic clues.

Management of Persistent Coccygodynia and Health Behavior: A Survey Study on Patients with Coccygodynia of Age 41 to 69 years.

Objectives: Coccygodynia, with trauma as a common etiologic factor, is a clinical condition of pain around the coccygeal region. This research aimed at investigating the level of satisfaction in surgical and non- surgical treatment of coccygodynia among Turkish patients and their health behavior. Methods: There is no dearth of studies on coccygodynia; however, a clear gap in research exists of studying coccygodynia patient satisfaction of specific age groups. Turkish patients aged 41 to 69 years and suffering from coccygodynia in different public sector clinics were the respondents in this research. The major criteria of sampling were Turkish patients of coccygodynia, aged 41 to 69 years, satisfied with both surgical and non-surgical methods of treatment, and varying in the nature of the infection. Results: The study found out that coccygodynia patients had a higher probability to receive timely, successful treatment; and that there exists a positive relationship between coccygodynia patients' health behavior and coccygodynia treatment satisfaction.Conclusion: This research is a significant contribution understanding the patients with coccygodynia, and whether they improved their health in a better way with surgical or non-surgical method of treatment.

Clinico-epidemiological study and laboratory profile of acute viral hepatitis in children of the age group 6 months to 12 years admitted in a tertiary care hospital

Background: Viral hepatitis is a major public health issue throughout the world affecting millions of children despite the availability of vaccines, prophylactic measures and improved sanitation. The objective of the study was to determine the etiological profile of acute viral hepatitis in patients admitted in a tertiary care hospital, West Bengal, India.Methods: This prospective hospital-based study was done in, Midnapore Medical College, Paschim Medinipur, West Bengal, India from February 2020 to July 2021. Children between 6 months to 12 years who presented with fever and prodromal symptoms, with or without jaundice, abdominal pain, high coloured urine, pale coloured stools with suspicion of acute viral hepatitis were included in the study. The data were statistically analysed using Microsoft excel and statistical package for the social sciences (SPSS) software.Results: Majority of the study subjects were from Lower middle class i.e. 59.6%. Only 34.6% regularly boiled water before consuming. Majority 44.2% of the subjects had history of practicing unhealthy eating practices which included not cleaning hands before eating. 66.7% subjects did not boiled water before consumption, 33.3% were involved in unhygienic food habits and 100% were using unhygienic sanitary practices. Prevalence of hepatitis A in our study was 96.2%. and hepatitis E was 5.8%. Prevalence of HAV IgM positive was 96.2%, prevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) positive was 1.9% and prevalence of HEV IgM positive was 5.8%.Conclusions: Prevalence of hepatitis A in our study was 96.2%. Hence, HAV was the most common etiological factor causing acute viral hepatitis in children. It’s important to create awareness in the society regarding preventive measures like hygienic food practices and improved sanitation which is of utmost importance in its prevention.

RETROSPECTIVE ANALYSIS OF GASTRITIS ASSOCIATED WITH CHRONIC ATROPHIC H. PYLORI IN PATIENTS WITH NOCARDIAL GASTRIC CANCER IN BUKHARA CITY AND PREVENTION OF ATROPHIC PROCESSES OF GASTRIC MUCOSA

Atrophic gastritis is understood as a progressive inflammatory process of the gastric mucosa, characterized by the loss of gastric glands. Helicobacter pylori infection (HP) and autoimmune gastritis are recognized as the most common etiological factors causing atrophic gastritis. The results of a retrospective analysis of the prevalence of chronic atrophic gastritis associated with H. pylori in patients with non-cardiac gastric cancer in Bukhara city were described. In addition, an algorithm for early diagnosis of atrophic processes of the gastric mucosa has been developed. When the incidence rate of chronic atrophic gastritis associated with H. pylori was analyzed in patients with non-cardiac gastric cancer in the city of Bukhara, it was noted that it tended to increase for 5 years from 2015 to 2019. Based on the research results, a personal algorithm for the formation of risk groups of atrophic processes of the gastric mucosa was developed. A personalized algorithm allows forming risk groups for atrophic processes of the gastric mucosa based on serological parameters, as well as taking into account data on genetic predisposition.

24-Hour Holter Monitoring for Identification of Arrhythmias in Elderly Heart Failure Patients: A Single-Centre Study.

Introduction Chronic heart failure (CHF)is a commoncondition seen in the elderly, and unlike coronary artery disease (CAD), its prevalence increases with age. Electrocardiography (ECG) at rest is a simple, non-invasive investigation that is recommendedin the initial evaluation of patients with heart failure. The purpose of this study was to identify various ECG abnormalities in elderly patients with heart failure and to find out whether Holter monitoring increases the chances of identifying arrhythmia in them. Materials and methods The current study was a single-centre, cross-sectional observational study. The study was conducted by collecting data from patients with heart failure attending the medicine and cardiology departments of All India Institute of Medical Sciences, Rishikesh, a tertiary care facility, from May 1st, 2020, to October 31st, 2021. The goal of this study was to look for electrocardiographic abnormalities in elderly heart failure patients who had a reduced (<50%) or preserved (>=50%) left ventricular ejection fraction (LVEF). All consecutively admitted patients who fulfilled the inclusion criteria were enrolled in the study after taking informed consent. All patients underwent echocardiography, electrocardiography and Holter monitoring. Demographic parameters were collected on a pre-formed proforma, and data was entered into an Excel sheet. Results A total of 101 patients were analyzed, and abnormal ECG results were found in 98% of them. Out of 101 patients,80 (79.2%) patients hadheart failure with reduced ejection fraction (HFrEF), withLVEF < 50%,and 21 (20.8%) patients had heart failure with preserved ejection fraction (HFpEF), with LVEF >=50%. Hypertensive heart disease was the most common etiological factor attributing to heart failurein 37 (36.6%) patientsand more among heart failure with reduced EF (p=0.01) followed by ischemic heart disease. Old ischemic changes were the commonest ECG abnormality, found in 48 (47.53%) patients with heart failure and among 45 patients (56.25%) with HFrEF (p=<0.001 ). Atrial fibrillation was the most common arrhythmia, occurring in 25 (24.75%) patients with heart failure. The detection rate of arrhythmia by Holter was better than surface ECG in patients with HErEF (p=0.007). Conclusion Electrocardiogram (ECG) in elderly heart failure patients is almost always abnormal. The majority of the patients in our study had more than two ECG abnormalities. ECG is a simple non-invasive tool that can detect underlying etiological factors attributing to heart failure. Holter monitoring can be done as an additional modality to detect arrhythmias in heart patients with reduced ejection fraction for risk stratification.

ОСОБЕННОСТИ ХРОНИЧЕСКИХ ПЕРИОДОНТИТОВ, ОСЛОЖНЕННЫХ ФУРКАЦИОННЫМИ ДЕФЕКТАМИ. ОБЗОР ЛИТЕРАТУРЫ

Periodontal tissue diseases remain one of the urgent problems in modern dentistry due to their high prevalence and the number of complications after treatment. The prolonged asymptomatic course of chronic forms of periodontitis causes an increase in destructive processes not only in periodontal tissues and alveolar bone, but also contributes to the resorption of cementum and root dentin, which causes the formation of bone pockets, called furcation defects. Involvement in the pathological process of the zone of divergence of the roots significantly complicates the course of the disease, diagnosis, treatment and prognosis. The complexity of diagnosis, the variability of treatment methods depending on the overall clinical picture and the high percentage of tooth loss when the furcation area is involved in the pathological process determine the relevance of the research topic. Purpose: to study the features of chronic periodontitis complicated by furcation defects and to identify the main causes of these defects. Materials and Methods: the analysis of domestic and foreign publications placed in the eLibrary and PubMed databases was carried out by keywords. Results. The analysis of literature data on the features of chronic periodontitis complicated by furcation defects is carried out, the issues of the etiology of this pathology are considered. Conclusion. It is shown that the treatment of chronic apical periodontitis complicated by furcation defects is one of the important problems of dentistry, which is determined by the significant prevalence of the disease and the incidence of complications after treatment. The most common etiological factor in furcation lesions is microbial invasion, which causes an inflammatory process, the progression of which leads to bone resorption in the area of the furcation arch of the teeth. Also, the etiological factors of periodontal pathogenic genesis, endodontic lesions, fractures, iatrogenic factors, as well as anatomical features contribute to the involvement of furcation.

Cytohistopathological Correlation of 884 Cervical Pap Smears as Bethesda System 2014: A Hospital-Based Study

Cervical carcinoma is most common in Indian women of which Rural women are predominantly affected. The most common etiological factor is human papillomavirus (HPV ). The present study aims to assess the diagnostic accuracy, sensitivity, specificity, and different patterns of cervical Pap smears by comparing histological findings. The index study is a retrospective cross-sectional analytical study. The data was collected at the pathology department from May 2017 to December 2019 according to hospital ethical protocol. Cervical Pap smears received by the pathology department underwent Pap staining. A total of 884 Pap smears were satisfactory and included in the study. The age of enrolled women was 46.4 ± 9.7 years. 800 cervical Pap smears were reported as negative for intraepithelial lesion (NILM), and 84 Pap smears were reported as abnormal. Abnormal pap smears included 64 (7.1%) atypical squamous cell-undetermined significance (ASC-US), 9 (1.01%) low-grade squamous intraepithelial (LSIL), 5 (0.56%) high-grade squamous intraepithelial lesion cannot be ruled out (ASC-H), 3 cases (0.33%) of high grade squamous intraepithelial lesion (HSIL), 2 cases (0.22%) of atypical glandular cell-not specific otherwise (AGC-NOS) and 1 case (0.11%) of squamous cell carcinoma. The cytohistological correlation was found in 56 patients, including 41.07% with chronic cervicitis, 26.75% with chronic cervicitis with squamous metaplasia, 5.35% with cervical polyps, 3.57% with CIN-1, 14.28% with carcinoma in situ, 7.14% with squamous cell carcinoma (keratinizing), 1.78% with squamous cell carcinoma (non-keratinizing) patients. Cytohistological correlation of 56 cases revealed sensitivity (83.33%), specificity (94.73%), PPV (88.23%), NPV (92.3%) and accuracy (91.07%). The cervical Pap test is cost-effective, almost as sensitive, and accurate as histology in screening for cervical lesions.

Endodontic treatments on permanent teeth in pediatric patients aged 6–12 years old

The prevalence of carious lesions and traumatic injury in individuals between ages 6 and 12 is high. This study aimed to characterize pediatric patients aged 6–12 treated in the endodontic clinic and investigate the prevalence and patterns of their provided endodontic treatments. Clinical and radiographic records of patients (ages 6–12) referred to the postgraduate Endodontics clinic from June 2017 to June 2020 were reviewed. Demographics, pre-and post-operative conditions, type of endodontic treatment, and behavioral management were collected. A total of 6350 teeth from 6089 patients were treated in this period, and 425 teeth (6.7%) from 405 patients were included. Ages 9–11 were the most commonly treated age group. Significantly more lower molars (41.9%) and upper anterior teeth (36.7%) were treated ( P < 0.05). The majority of teeth were diagnosed with pulp necrosis (39.5%), and the most common periapical diagnosis was normal apical tissues (39.8%), then symptomatic apical periodontitis (38.8%). The most common etiological factor was caries (63.5%). Two hundred six teeth (48.5%) were treated with root canal therapy, 161 teeth (37.9%) with vital pulp therapy, 46 teeth (10.8%) with apexification or regenerative endodontic procedure, 12 teeth (2.8%) with non-surgical retreatment. A statistically high number of patients (87.8%) tolerated the endodontic procedures without any sedation ( P < 0.0001). Pediatric patients aged 6–12 compose around 7% of the population treated at the postgraduate Endodontics clinic, reflecting the high demand for endodontic treatment in a pediatric mixed dentition population.

Consistent downregulation of the cleft lip/palate-associated genes IRF6 and GRHL3 in carcinomas.

Interferon Regulatory Factor 6 (IRF6) and Grainyhead Like Transcription Factor 3 (GRHL3) are transcription factors that orchestrate gene regulatory networks required for the balance between keratinocyte differentiation and proliferation. Absence of either protein results in the lack of a normal stratified epidermis with keratinocytes failing to stop proliferating and to terminally differentiate. Numerous pathological variants within IRF6 and GRHL3 have been identified in orofacial cleft-affected individuals and expression of the two transcription factors has been found to be often dysregulated in cancers. However, whether orofacial cleft-associated IRF6 and GRHL3 variants in patients might also affect their cancer risk later in life, is not clear yet. The fact that the role of IRF6 and GRHL3 in cancer remains controversial makes this question even more challenging. Some studies identified IRF6 and GRHL3 as oncogenes, while others could attribute tumor suppressive functions to them. Trying to solve this apparent conundrum, we herein aimed to characterize IRF6 and GRHL3 function in various types of carcinomas. We screened multiple cancer and normal cell lines for their expression, and subsequently proceeded with functional assays in cancer cell lines. Our data uncovered consistent downregulation of IRF6 and GRHL3 in all types of carcinomas analyzed. Reduced levels of IRF6 and GRHL3 were found to be associated with several tumorigenic properties, such as enhanced cell proliferation, epithelial mesenchymal transition, migration and reduced differentiation capacity. Based on our findings, IRF6 and GRHL3 can be considered as tumor suppressor genes in various carcinomas, which makes them potential common etiological factors for cancer and CLP in a fraction of CLP-affected patients.

The Role of Viruses in the Inception of Chronic Rhinosinusitis.

Chronic rhinosinusitis (CRS) is a complex inflammatory disorder that affects between 2% and 16% of adults in the United States, with estimated healthcare costs between 4 and 12 million USD. Viruses are a common etiologic factor for URIs, are frequently identified in the sinuses of patients with CRS, and trigger CRS exacerbations. Therefore, investigating the role of viruses provides an opportunity to identify their role in the pathogenesis of CRS. In this review, we identified the viruses frequently isolated in patients with CRS, as well as their associated immunologic responses and contributions to inflammation. Rhinovirus, parainfluenza virus, influenza virus, and respiratory syncytial virus are the viruses commonly found in patients with CRS. This information allows us to target pathways early in the pathogenesis of CRS, thereby playing a significant role in slowing the progression of this chronic disease.

Etiological Risk Factors Profile of Arterial Ischemic Stroke in Children at A Tertiary Care Children's Hospital

Objective: To determine the etiological risk factors of arterial ischemic stroke (AIS) in children. Study Design: An observational cohort study. Place and Duration of the Study: Neurology department of “The Children's Hospital and Institute of Child Health, Multan”, from January 2020 to December 2020. Methods: Children in the age group from one month of age to 12 years with a history of acute onset of focal neurological deficit of upper motor nerve and positive findings on neuroimaging were included in the study. The workup included baseline lab testing, neuroimaging, cardiac evaluation, and cerebro-spinal fluid (CSF) laboratory testing. We used predesigned proforma for recording the patient's details and the possible etiology of the stroke. Results: In a total of 84 children, 28 (33.3%) were male and 56 (66.7%) were female. Age ranged from 4 months to 11 years with a mean age of 3.4±2.2 years. Etiological risk factors identified in 62 (73.8%) patients and were remained undetermined in 22 (26.2%) patients. The risk factors identified were central nervous system infection arteriopathy in 22 (26.2%), iron deficiency anemia 20 (23.8%), cardiac disorders 11 (13.1%), moyamoya disease in 5 (6.0%), and mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes in 4 (4.8%) patients. Practical Implications: It is essential to know the etiology of risk factors responsible for AIS as the management and prognosis are directly influenced by them. Conclusion: Infection-associated arteriopathy was the most common etiological risk factor for arterial ischemic stroke in our study population. Keywords: Anemia, arterial ischemic stroke, central nervous system, moamoya