Etiological Factors Research Articles

The multiple trajectories of the allergic march.

The allergic march comprises the sequential appearance of a series of allergic comorbidities. However, variability in the onset and progression of allergic diseases generates a heterogeneous scenario that does not follow a linear and single trajectory. Almost half of the pediatric population presents at least 1 allergy symptom. However, only 4%-6% present multimorbidity, with several allergic diseases co-occurring. It has recently been shown that although they share etiological mechanisms and risk factors, allergic diseases arise independently. In most cases, progression is not consecutive, or at least not the same in all patients. TH2- mediated inflammation, epithelial barrier dysfunction, and genetic predisposition play a fundamental role in the etiology of allergic diseases, on which the interaction with the exposome acts decisively. Therefore, studying diseases from an omics point of view is essential when attempting to describe the various trajectories of allergic progression and to propose effective interventions to prevent multimorbidity. In this narrative review, we provide an overview of the current perception of the allergic march, including clinical observations, omics data, risk factors, and measures aimed at modifying its course or even preventing its onset.

Calcaneus stress fracture: a case report

Calcaneal stress fracture is a rare clinical entity associated with diverse etiological factors such as high intensity training, female sex, smoking and poor nutrition. The authors present a case of a calcaneal stress fracture treated conservatively with immobilization, limited weight bearing and vitamin D supplementation.

Impact of the COVID-19 pandemic on maxillofacial trauma surgery in Germany - implications from the national DRG database.

The COVID-19 pandemic has affected the personal and social lives of millions of people and also impacted the etiological factors of midfacial trauma such as falls, interpersonal violence or traffic accidents. The aim of this study was to analyze the influence of the COVID-19 pandemic on maxillofacial trauma surgery in the German healthcare system. Nationwide data regarding the national diagnosis-related-group (DRG) inpatient billing system used in all German hospitals was received from the German Federal Statistical Office. Various trauma-associated procedures of the Operation and Procedure Classification System (OPS), a German modification of the International Classification of Medical Procedures (ICPM), were statistically associated with different epidemiological factors between 2012 and 2021. A statistically significant decrease (p < 0.05) in surgeries regarding maxillofacial fractures was registered during the years 2020 and 2021. Young male patients had the largest decline in maxillofacial trauma surgeries during this period (p < 0.05). In contrast. elderly patients 80 years and older showed a dramatic increase in the frequency of fractures in both the midface and the mandible (p < 0.05). During the COVID 19 pandemic there has been a shift in the number, composition and etiology of maxillofacial fracture surgeries. Measures of social distancing and personal risk avoidance had a societal positive effect on the frequency of facial injuries. This stands in contrast to the drastic increase in fractures of elderly people who should be protected primarily by the measures taken. These results can help to understand these influences better in future pandemics. German Clinical Trials Register No: DRKS00032778.

Role of Gut-Brain Axis in Autism Spectrum Disorder: a Focus on the Neuroinflammation and Microglial Polarization

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects communication, social behavior and gives rise to repetitive behaviors and restricted interests. The complexity of ASD suggests the influence of multiple etiological factors, including genetic, environmental and immunological elements. Recently, the gut-brain axis has emerged as a significant field of interest, proposing an intriguing connection between the composition of the gut microbiota and the neurobehavioral manifestations of ASD. This narrative review explores the current evidence linking the gut-brain axis to neuroinflammation and microglial polarization in the context of ASD. This review highlights the importance of integrated approaches to understanding the complexity of ASD, pointing to the need for further research exploring the role of the gut-brain axis as a potential therapeutic target. We conclude that a deeper understanding of the interactions between gut microbiota, neuroinflammation and microglial activity may reveal new avenues for more effective interventions in ASD.

A 5-year comprehensive evaluation of maxillofacial injuries in polytrauma patients at a tertiary hospital – an epidemiological study

Objectives: To report and analyze the pattern of maxillofacial injuries in trauma victims and to define the role of a maxillofacial surgeon in an emergency trauma care team. Materials and methods: Trauma patients reported and reporting to the casualty of a tertiaryhospital with facial injuries and other suspected concomitant injuries in the body were included in this study. The complete medical and radiographic records of each patient were reviewed and data was collected in a standard proforma in this 5-year clinical study (3 year of retrospective and 2 year of prospective study). The complete data related to the facial injuries and associated systemic trauma was recorded and statistical analysis conducted. Results: A total of 18,369 patients with trauma were admitted to the hospital from May 2018 to April 2023. Out of these, 11,277 (61.4%) were males and 7,092 (38.6%) were females. Seventy percent of the reported cases with trauma were in the age group of 14–40 years. The incidence of trauma during the monsoon season was highest (n = 7,927, 43%). The commonest etiological factor leading to trauma was road traffic accident (n = 4,510, 40%). Among facial injuries, the mandibular fractures (n = 1,821, 41%) were predominant. Conclusions: The management of polytrauma patients should be undertaken by a team of specialists which should include a maxillofacial surgeon as facial injuries were common. This data is essential in developing and assessing the preventative strategies aimed at decreasing the frequency of facial and other injuries.

Occupational exposure to organic solvents and the risk of developing testicular germ cell tumors (TESTIS study): Effect of combined exposure assessment on risk estimation.

Etiological factors of testicular germ cell tumors (TGCT) remain largely unknown, but a causal role of occupational exposures to solvents has been suggested. Previous studies analyzing these exposures reported discordant results, potentially related to exposure assessment methods. The aim of this study was to investigate the role of occupational exposure to solvents on the risk of developing TGCT among young men. This study examined occupational exposures to solvents and TGCT risk based on the lifetime work histories of 454 cases and 670 controls, aged 18-45 years, of the French national TESTIS case-control study. Solvent exposure was estimated using: (i) exposure assignment by job-exposure matrix (JEM) and (ii) JEM combined with self-reported exposure data from specific questionnaires (SQ) and expert assessment (EA). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. Both approaches (JEM and JEM+SQ+EA) showed a consistent association between TGCT and trichloroethylene exposure (exposed versus not exposed; JEM=OR 1.80 [95% confidence interval (CI) 1.12-2.90] and JEM+SQ+EA= OR 2.59 (95% CI 1.42-4.72). Both approaches also observed positive associations with ketone esters and fuels & petroleum-based solvents. The results suggest that some organic solvents might be involved in the pathogenesis of TGCT among occupationally exposed men. The combined use of JEM+SQ+EA seemed to limit misclassification by considering individual exposure variability and is, therefore, an appealing approach to assess occupational exposures in epidemiological studies.

Activation of the IKK2/NF-κB pathway in VSMCs inhibits calcified vascular stiffness in CKD.

IKK2/NF-κB pathway-mediated inflammation in vascular smooth muscle cells (VSMCs) has been proposed to be an etiologic factor in medial calcification and stiffness. However, the role of the IKK2/NF-κB pathway in medial calcification remains to be elucidated. In this study, we found that chronic kidney disease (CKD) induces inflammatory pathways through the local activation of the IKK2/NF-κB pathway in VMSCs associated with calcified vascular stiffness. Despite reducing the expression of inflammatory mediators, complete inhibition of the IKK2/NF-κB pathway in vitro and in vivo unexpectedly exacerbated vascular mineralization and stiffness. In contrast, activation of NF-κB by SMC-specific IκBα deficiency attenuated calcified vascular stiffness in CKD. Inhibition of the IKK2/NF-κB pathway induced cell death of VSMCs by reducing anti-cell death gene expression, whereas activation of NF-κB reduced CKD-dependent vascular cell death. In addition, increased calcification of extracellular vesicles through the inhibition of the IKK2/NF-κB pathway induced mineralization of VSMCs, which was significantly reduced by blocking cell death in vitro and in vivo. This study reveals that activation of the IKK2/NF-κB pathway in VSMCs plays a protective role in CKD-dependent calcified vascular stiffness by reducing the release of apoptotic calcifying extracellular vesicles.

Epileptic spasms relapse is associated with response latency but not conventional attributes of post-treatment EEG.

Relapse of epileptic spasms after initial treatment of infantile epileptic spasms syndrome (IESS) is common. However, past studies of small cohorts have inconsistently linked relapse risk to etiology, treatment modality, and EEG features upon response. Using a large single-center IESS cohort, we set out to quantify the risk of epileptic spasms relapse and identify specific risk factors. We identified all children with epileptic spasms at our center using a clinical EEG database. Using the electronic medical record, we confirmed IESS syndrome classification and ascertained treatment, response, time to relapse, etiology, EEG features, and other demographic factors. Relapse-free survival analysis was carried out using Cox proportional hazards regression. Among 599 children with IESS, 197 specifically responded to hormonal therapy and/or vigabatrin (as opposed to surgery or other second-line treatments). In this study, 41 (21%) subjects exhibited relapse of epileptic spasms within 12 months of response. Longer duration of IESS prior to response (>3 months) was strongly associated with shorter latency to relapse (hazard ratio = 3.11; 95% CI 1.59-6.10; p = 0.001). Relapse was not associated with etiology, developmental status, or any post-treatment EEG feature. This study suggests that long duration of IESS before response is the single largest clinical predictor of relapse risk, and therefore underscores the importance of prompt and successful initial treatment. Further study is needed to evaluate candidate biomarkers of epileptic spasms relapse and identify treatments to mitigate this risk. Relapse of infantile spasms is common after initially successful treatment. With study of a large group of children with infantile spasms, we determined that relapse is linked to long duration of infantile spasms. In contrast, relapse was not associated with the cause of infantile spasms, developmental measures, or EEG features at the time of initial response. Further study is needed to identify tools to predict impending relapse of infantile spasms.

PRE- AND POST-NATAL METHODS FOR PREVENTING EARLY CHILDHOOD CARIES

In general, the world recognizes the lack of preventive measures against dental caries in children, as evidenced by itsprevalence and intensity with a signifi cant range of fl uctuations.The aim of the study. To describe modern approaches to the prevention of early childhood dental caries in children basedon the analysis of foreign and domestic literature.Materials and methods. The study used the bibliosemantic method and structural and logical analysis. The electronicdatabases PubMed, MEDLINE, Scopus, Web of Science and EMBASE were used to search modern scientifi c literature using the key words «early childhood caries», «macro and trace elements», «probiotics», «prenatal prevention», «postnatal prevention», «oral cavity microfl ora».Results and discussion. At this stage of caries development, the most eff ective prevention programs are those developedon the basis of methods to minimize the impact of risk factors for the development of the disease, such as microbial plaque,low resistance of dental tissues to demineralization, frequent consumption of carbohydrates. The practical implementation of comprehensive prevention programs is very diffi cult, as it should be carried out before the birth of a child and continue throughout life. Often the role of the dentist is to organize and monitor the program, while specifi c preventive measures can and should be implemented by health and education authorities, medical personnel, parents and educators. The greatest impact will be achieved through collaboration among specialists in various medical and non-medical fi elds.Conclusions. Based on the analysis of the literature, there is a great interest of the world’s leading scientists in the prevention of early childhood caries. However, the problems of developing adapted preventive measures taking into account etiologic factors remain relevant.

Impact of Equine Ocular Surface Squamous Neoplasia on Interactions between Ocular Transcriptome and Microbiome.

Ocular surface squamous neoplasia (OSSN) represents the most common conjunctival tumor in horses and frequently results in vision loss and surgical removal of the affected globe. Multiple etiologic factors have been identified as contributing to OSSN progression, including solar radiation exposure, genetic mutations, and a lack of periocular pigmentation. Response to conventional treatments has been highly variable, though our recent work indicates that these tumors are highly responsive to local immunotherapy. In the present study, we extended our investigation of OSSN in horses to better understand how the ocular transcriptome responds to the presence of the tumor and how the ocular surface microbiome may also be altered by the presence of cancer. Therefore, we collected swabs from the ventral conjunctival fornix from 22 eyes in this study (11 with cytologically or histologically confirmed OSSN and 11 healthy eyes from the same horses) and performed RNA sequencing and 16S microbial sequencing using the same samples. Microbial 16s DNA sequencing and bulk RNA sequencing were both conducted using an Illumina-based platform. In eyes with OSSN, we observed significantly upregulated expression of genes and pathways associated with inflammation, particularly interferon. Microbial diversity was significantly reduced in conjunctival swabs from horses with OSSN. We also performed interactome analysis and found that three bacterial taxa (Actinobacillus, Helcococcus and Parvimona) had significant correlations with more than 100 upregulated genes in samples from animals with OSSN. These findings highlight the inflammatory nature of OSSN in horses and provide important new insights into how the host ocular surface interacts with certain microbial populations. These findings suggest new strategies for the management of OSSN in horses, which may entail immunotherapy in combination with ocular surface probiotics or prebiotics to help normalize ocular cell and microbe interactions.

Decompensated liver cirrhosis: assessment of complications and mortality in hospitalised patients

Background. Liver cirrhosis is a severe, progressively fatal disease if untreated. Hospitalised patients face high mortality rates, and current methods for assessing prognosis vary widely. The research aims to investigate complications and predictors of mortality in patients admitted for decompensated cirrhosis to a tertiary care centre in Tirana, Albania. Materials and methods. The retrospective study included 212 patients aged (58.67 ± 10.09) years: 174 (82.1 %) men, 38 (17.9 %) women. The Child-Turcotte-Pugh, MELD, MELD-Na, MELD 3.0, iMELD, MESO, and UKELD scales were used to assess the severity of the condition and risk stratification of patients. The number of patients with a fatal outcome was 43 (20.3 %). Results. Among participants with different etiological factors of liver cirrhosis, the mortality rate did not differ significantly (p = 0.873). The presence of hepatic encepha­lopathy (0.43; p = 0.001), acute-on-chronic liver failure (r = 0.47; p = 0.001) and hepatorenal syndrome (r = 0.49; p = 0.001), and, to a lesser extent, ascites (r = 0.18; p = 0.006) and spontaneous bacterial peritonitis (r = 0.23; p = 0.041) was a marker of unfavourable prognosis of hospitalisation. Also, the risk of death increased in the presence of leukaemia (hazard ratio = 4.21 (1.65; 10.74); p = 0.003). Conclusions. The MELD 3.0 and MELD-Na scores, calculated based on laboratory values obtained within 48–72 hours of hospitalisation, were found to be the prognostically significant (p &lt; 0.05)

Antibacterial therapy for kidney pathology of small pets

The article considers etiological factors, clinical manifestations, laboratory and instrumental methods for diagnosing kidney pathology, which requires the use of antibacterial drugs – pyelonephritis. However, this pathology can be difficult to diagnose and not every antibacterial drug is suitable for its treatment. The main ways of kidney damage by bacterial infection in small domestic animals are ascending infection and hematogenous introduction, when pathogenic microorganisms enter the kidneys along with the bloodstream. The article provides predisposing factors leading to the development of pyelonephritis. Pyelonephritis has several types of course. The acute form of the disease is most easily diagnosed due to the vivid clinical signs and pronounced changes in blood, urine, and kidney sonography tests. Whereas the chronic form and latent course may be overlooked due to the nonspecific clinical picture. In the treatment of pyelonephritis, the occurrence of antibiotic resistance in bacteria can be fatal for the patient, because if it is impossible to eliminate infection in the kidneys, the development of renal failure is inevitable, leading to all manifestations of uremia, anemia and other changes that occur with impaired renal function. To prevent the development of antibiotic resistance, it is extremely important to make a final diagnosis through bacteriological urine culture, but pyelonephritis is a pathology that requires a comprehensive diagnostic approach and, if suspected, it is advisable to start etiological treatment immediately, correctly choosing an antibiotic. Not every antibacterial drug is suitable for the treatment of pyelonephritis. For example, one of the first-line drugs of choice in the treatment of urinary tract infection (UTI), amoxicillin with clavulanic acid does not penetrate the renal parenchyma. The group of choice for the treatment of bacterial inflammation of the kidneys are fluoroquinolones, but not every drug from this group is suitable for treatment in animals and there are certain restrictions in their use in the case of puppies, kittens, as well as in cats as a species, therefore, the selection of an antibiotic should be carried out individually in each clinical case, taking into account the pharmacokinetics and pharmacodynamics of the drug, the result of urine sampling and other studies, as well as the physiological characteristics of the patient.

Etiological Assessment of Splenomegaly by Clinical and Laboratory Methods in Paediatric Age Group (3 Months To 18 Years)

Introduction: Splenomegaly is the enlargement of spleen. Splenomegaly is a sign seen in various disease processes in infants and children. So, an attempt was made in the present study to know the various etiological factors and clinical features and clinical outcome of splenomegaly in the cases admitted in Prathima institute of medical sciences, Nagunoor, KarimnagarAim and objectives: 1. To establish the possible etiology of Splenomegaly in children by clinical and laboratory methods.Material and methods: 100 children from 3 months to 18years, with varying grades of Splenomegaly of different etiologies, admitted to paediatric wards of Prathima Institute of Medical Sciences, Karimnagar were studied in this observational study between Decembers 2015 to November 2017. Detailed study of each case including history, thorough physical examination and necessary investigations were done to reach the diagnosis.Results: Male preponderance was seen in present study. Maximum incidence of Splenomegaly was seen between 3 months to 6 years age group (62%). Majority of the cases had moderate Splenomegaly (62%). Fever was the most common presenting feature associated with Splenomegaly. Hepatomegaly was the most common association with Splenomegaly. Infections (42%) were the most common cause of Splenomegaly, followed by hematologic (25%) causes.Conclusions: Infections was the most common cause of Splenomegaly in present study. Male preponderance was seen; majority of cases had moderate Splenomegaly and belonged to preschool age group.

Occupational health risk for women employed in industries with harmful working conditions

The preservation and strengthening of the health of the able-bodied population is the most important indicator of the socio-economic potential of the country.&#x0D; A modern working woman experiences the complex impact of adverse factors of the production environment and the labor process, which are potentially dangerous to health, contribute to the formation of production-related and occupational diseases.&#x0D; The study aims to analyze the occupational health risk of women employed in jobs with harmful working conditions at the processing plant of the mining and processing plant and the petrochemical complex of the Republic of Bashkortostan.&#x0D; Materials and methods. The authors studied the state of health by analyzing the occupational risk of female workers in contact with harmful production factors of a processing enterprise (407 people) and a petrochemical complex (473 people). The experts used clinical, functional, clinical and statistical research methods in their work and analyzed the levels and structure of chronic non-communicable diseases to determine the degree of industrial conditionality. The calculations were performed using the Microsoft Excel program.&#x0D; The combined effect of a complex of harmful production factors of the mining and processing plant (dust of polymetallic ores, chemicals, noise and severity of labor — class of working conditions 3.1) contributes to the development of chronic non-communicable diseases in female workers in 80.3±2.0% of cases, versus 54.6±4.4% of cases in the control group. A number of identified diseases have the character of production-related, while a very high degree of its conditionality is characteristic of diseases of the musculoskeletal system and connective tissue (RR — relative risk = 4.3, EF — etiological proportion = 75%), a high degree was inherent in respiratory diseases (RR=3.1; EF=67.7%). Diseases of the circulatory system (RR=1.6, EF=37.5%) and diseases of the nervous system (RR=1.58, EF=36.7%) had an average degree of occupational &#x0D; conditionality.&#x0D; In the workers of the main group of the petrochemical complex, chronic non–communicable diseases were diagnosed significantly more often than in the control, respectively — 84.0±1.7 and 67.0±3.5% of cases, p&lt;0.01. The combined effect on the workers of the complex of chemicals in combination with the intensity of the labor process associated with the 3-shift nature of work (class of working conditions 3.1), was the cause of the industrial conditionality of diseases of the nervous system, circulatory system, blood, digestive organs of moderate degree.&#x0D; Female employees of the enterprises of the concentrating plant of the mining and processing plant and the petrochemical complex, engaged in work with harmful working conditions, represent a "risk group" for the occurrence of changes from various organs and systems, depending on the current etiological production factors. Based on the indicators of the degree of occupational conditionality of a number of diseases in female workers, mining and petrochemical complexes belong to industries with a high and medium occupational risk of health disorders.&#x0D; Ethics. The survey of female employees was conducted with their informed consent, approved by the bioethical committee of the Institute. The fundamental documents are: "Ethical principles of conducting scientific medical research with human participation" (amendments 2008) of the Helsinki Declaration, as well as "Rules of Clinical Practice in the Russian Federation" (approved by Order of the Ministry of Health dated 06/19/2003 No. 266).

Distal Rotational Metatarsal Osteotomy (DROMO) for the treatment of hallux valgus associated with first metatarsal pronation: Surgical technique and initial results

BackgroundHallux valgus (HV) is a very common deformity worldwide. Most of the surgical techniques used in the treatment of HV only correct these deformities in two planes, that is sagittal and transverse planes. The importance of the first metatarsal pronation as an etiological factor of hallux valgus is validated by numerous authors and it is usually unaddressed. Few surgical techniques have focused on the correction of rotational deformity of the hallux valgus. We aim to first report a detailed technique and a case series using the Distal Rotational Metatarsal Osteotomy (DROMO) surgical technique, which is less invasive and can address the pronation deformation. MethodsThe inclusion period was 6 months finishing in April 2021. The study analyzed the following x-ray parameters: preoperative and postoperative intermetatarsal angle (IMA), preoperative and postoperative hallux valgus angle (HVA), preoperative and postoperative coronal rotation of the first metatarsal according Hardy and Clapham’s classification as described by Kim et al., preoperative and postoperative shape of the first metatarsal head as described by Ono et al. Results33 patients matched our inclusion and exclusion criteria. Most patients underwent the surgery for the left foot (n = 18), compared to the right foot (n = 15). We found statistically significant differences between preoperative and postoperative IMA (p < 0.001), preoperative and postoperative HVA (p < 0.001). Preoperative and postoperative coronal rotation of the first metatarsal as classified by Hardy and Clapham was significantly different (p < 0.001), as well as preoperative and postoperative shape of the first metatarsal head (p < 0.01). ConclusionsDROMO can correct the metatarsal rotation through minimal invasive surgery. From our perspective, DROMO technique should be another alternative for HV correction technique which in time can be associated as a local anesthetic technique, DROMO results are attractive for an ambulatory procedure.

Treatment of a Cushing's ulcer in a 7-y.o. child after a tumor (medulloblastoma) removal in ventricle IV

BACKGROUND: Cushing's ulcer is a stress ulcer in the stomach or duodenum which basic etiological factor is increased intracranial pressure. The increased intracranial pressure is caused, most often, by intracranial neoplasms, cranial-cerebral injury or previous neurosurgical interventions. Cushing's ulcers are usually solitary and deep, often complicated with recurrent gastrointestinal bleedings and less often with perforations. In cases of suspected perforation in a complex anatomical localization (posterior wall of the duodenum), the method of choice according to the world literature is computed tomography with intravenous contrast. Subsequently, after brief preoperative preparation, indications for laparoscopy or laparotomy with subsequent ulcer closure are determined. In the absence of free gas in the abdominal cavity, the "gold standard" for diagnosis and treatment is esophagogastroduodenoscopy. During esophagogastroduodenoscopy, it is necessary to visualize the source of gastrointestinal bleeding and determine if it is ongoing. In cases of ongoing gastrointestinal bleeding, endoscopic hemostasis is performed. If it is not possible to establish the source of bleeding and/or if local hemostasis attempts are unsuccessful, endovascular arterial embolization is recommended. If all minimally invasive methods are ineffective, radical methods such as laparoscopy or laparotomy with visualization of the source of bleeding, cessation of bleeding, and ulcer closure are employed. Clinical Case Description. This clinical case demonstrates the severity and unpredictability of the clinical course of Cushing's ulcer complicated by gastrointestinal bleeding. The patient underwent multiple hemostatic procedures through esophagogastroduodenoscopy and arterial embolization. However, despite all minimally invasive treatment methods, the patient's condition required radical surgical treatment. CONCLUSION: There is no information in the world literature about the algorithm for managing recurrent gastrointestinal bleeding in the context of Cushing's ulcer. The authors recommend to covert to more radical treatment only after all minimally invasive techniques turned to be ineffective.

Analysis of inflammation and bone remodeling of atmospheric plasma therapy in experimental periodontitis.

The biological effects of atmospheric plasma (cold plasma) show its applicability for controlling the etiological factors that involve tissue repair. Thus, the study evaluated the effect of atmospheric plasma therapy in the control of tissue inflammation and bone remodeling in experimental periodontitis. Fifty-six rats were subjected to ligation in the cervical region of the first maxillary molars (8 weeks). The animals were divided into two groups (n = 28): periodontitis without treatment group (P group), and periodontitis with atmospheric plasma treatment group (P + AP group). Tissue samples were collected at 2 and 4 weeks after treatment to analyze the inflammation and bone remodeling by biochemical, histomorphometric, and immunohistochemical analyses. Inflammatory infiltration in the gingival and periodontal ligament was lower in the P + AP group than in the P group (p < .05). The MPO and NAG levels were higher in the P + AP group compared to P group (p < .05). At 4 weeks, the TNF-α level was lower and the IL-10 level was higher in the P + AP group compared to P group (p < .05). In the P + AP group, the IL-1β level increased in the second week and decreased in the fourth week (p < .05), the number of blood vessels was high in the gingival and periodontal ligament in the second and fourth week (p < .05); and the number of fibroblasts in the gingival tissue was low in the fourth week, and higher in the periodontal tissue in both period (p < .05). Regarding bone remodeling, the RANK and RANKL levels decreased in the P + AP group (p < .05). The OPG level did not differ between the P and P + AP groups (p > .05), but decreased from the second to the fourth experimental week in P + AP group (p < .05). The treatment of experimental periodontitis with atmospheric plasma for 4 weeks modulated the inflammatory response to favor the repair process and decreased the bone resorption biomarkers, indicating a better control of bone remodeling in periodontal disease.

Different therapeutic approaches in melasma: advances and limitations.

Melasma is a chronic hyperpigmentation skin disorder that is more common in the female gender. Although melasma is a multifactorial skin disorder, however, sun-exposure and genetic predisposition are considered as the main etiologic factors in melasma occurrence. Although numerous topical and systemic therapeutic agents and also non-pharmacologic procedural treatments have been considered in melasma management, however, the commonly available therapeutic options have several limitations including the lack of sufficient clinical effectiveness, risk of relapse, and high rate of unwanted adverse drug reactions. Recruitment of nanotechnology for topical drug delivery in melasma management can lead to enhanced skin penetration, targeted drug delivery to the site of action, longer deposition at the targeted area, and limit systemic absorption and therefore systemic availability and adverse drug reactions. In the current review, first of all, the etiology, pathophysiology, and severity classification of melasma have been considered. Then, various pharmacologic and procedural therapeutic options in melasma treatment have been discussed. Afterward, the usage of various types of nanoparticles for the purpose of topical drug delivery for melasma management was considered. In the end, numerous clinical studies and controlled clinical trials on the assessment of the effectiveness of these novel topical formulations in melasma management are summarized.

Current Emerging Concepts on the Pathogenesis of Peri-implant Diseases: A Narrative Review.

The aim of this narrative review is to describe the emerging evidence concerning etiological factors and pathophysiological mechanisms involved in peri-implant inflammatory diseases. An electronic search for articles published until November 2022 was conducted in MEDLINE by three independent reviewers to identify manuscripts reporting data on etiological factors and pathophysiological mechanisms associated with peri-implant diseases. Current evidence suggests that peri-implant mucositis and peri-implantitis are inflammatory conditions linked to a microbial challenge. However, in recent years, there has been increasing evidence indicating that certain peri-implant inflammatory conditions may not be primarily related to biofilm-mediated infectious processes but rather to other biological mechanisms, such as a foreign body response. The current evidence, not only in the dental literature, opens new avenues for a more complex interpretation of the etiopathogenetic factors involved in peri-implant diseases. A better understanding of various factors related to the host response, including dysbiosis mechanisms associated with changes in microbiota composition, is necessary for a more precise physiopathological characterization of these diseases.

Cephalometric Assessment of Skeletal Class II Malocclusion in a Sample of Kurdish Population in Sulaimani City (Retrospective Study)

Objective: This retrospective comparative cephalometric study aims to identify the cephalometric features of skeletal class IImalocclusion in a sample of the Kurdish population, the result of this study willl be useful in diagnosing and treating orthodontic andjaw surgery.&#x0D; Methods: A total of 85 pre-treatment lateral cephalometric radiographs with skeletal class II malocclusion (ANB&gt;=4) and 81 withskeletal class I malocclusion (1=&lt;ANB&lt;4) were obtained from the pre-orthodontic patient records in a private orthodontic clinic inSulaimani city. The patients were between 18 and 35 years old. The lateral cephalometric radiographs were analyzed digitally usingFACAD cephalometric software. Twenty-two variables were measured from each cephalometric radiograph. The correlation betweenClass I and II was analyzed using the Mann-Whitney Test.&#x0D; Results: The result showed that the values of SNA, ANB, Y-axis, Convexity angle, Gonial angle, Intermaxillary angle, facial angleand FMA, posterior cranial base, effective maxillary length, LAFH were higher in skeletal Class II than in Class I cases, which indicatesthat skeletal class II Kurdish population have more vertical mandibular growth and prognathic maxilla, retrognathic mandible, andlonger face than class I. Meanwhile, SNB, Mandibular length, TFH, UAFH, Maxillary length, UI-Palatal plane angle, IMPA, andeffective mandibular length values were lower and the difference was statistically significant in the majority of cases.This illustratesthat the incisors are more proclined in class I than skeletal class II, whereas the mandible is shorter in skeletal class II patients. Theseresults summarize the characteristic features of skeletal class II patients in a sample of the Kurdish population in Sulaimani City, whichare caused by etiological factors (genetic, congenital). This information is useful for enabling orthodontists and maxillofacial surgeonsto attain a diagnosis and treatment plan for skeletal class II patients in a shorter period.&#x0D; Conclusions: Skeletal class II malocclusion in the Kurdish population is characterized by a prognathic but short maxilla, retrognathic,short, backward, and downward rotated mandible, and a prominent chin.