Etiological Factors Research Articles

Changes in Circulating Levels of Long Non-Coding RNA p5549 and p19461 Following Metabolic Bariatric Surgery (MBS): A Prospective Study.

Obesity is attributed to a combination of factors such as lifestyle, environmental influences, and genetic background. Nowadays, the issue of obesity has grown to an epidemic scale. Environmental changes, having contributed to the sharp rise in obesity prevalence, are not the only contributing etiologic factors. Inherent biological variables interact with environmental factors resulting in obesity. Epigenetic mechanisms may explain part of obesity heritability. One of the recently discovered epigenetic mechanisms for controlling gene expression is long non-coding RNAs (lncRNAs). Circulating lncRNA p5549 and p19461 levels were reported to be significantly lower in individuals with obesity. This study aimed to evaluate whether weight loss following metabolic/bariatric surgery (MBS) can be related to altered expression levels of those lncRNAs, which have been reported to be reduced in individuals with obesity. Comparison of circulating levels of lncRNA p5549 and p19461 before and 12weeks after MBS in thirty-four patients was conducted to evaluate whether MBS can revert the altered levels of these lncRNAs. None of the participating patients were lost to follow-up, and all underwent re-evaluation of post-surgical expression levels. lncRNA p5549 expression levels in serum were found to increase significantly in the postoperative samples compared to preoperative samples (fold increase: 4.63 ± 7.68, p = 0.014). Epigenetic changes in patients with obesity, specifically lncRNA-p5549 expression levels, are reversed after MBS. The postoperative increase in the expression levels of lncRNA- p19461 was not statistically significant.

Practical Approach of Trayopstambha in Preventing Autoimmune Disorders

Trayopstambha are – Aahar, Nidra and Brahmcharya. All of them are helpful for living a healthy life. In all autoimmune disease like Rheumatoid Arthritis, Lupus Erythematous, Celiac diseases, Polymyalgia, Multiple Sclerosis, Type 1 DM and Alopecia aerata body immune system is affected due to over activity of free radicals. Free radicals’ activity is increased due to disbalance in Trayopstambha. Aama Rasa is responsible for development of all autoimmune diseases. This Aama Rasa can be compared to free radical which causes destruction of healthy tissues. Aama's etiological factors may be classified as Aharja, Viharaja and Manasika. Not only food in larger amount, but also qualities such as Guru, Sheeta, Shushka, Ruksha, Vidahi, Viruddha Ahara (incompatible diet), Ajeernabhojana (indigestion), Asatmya Bhojana (toxic food) or Abhojana (self-restraint from food), Deevasvapna (keeping wakeful in the night and sleeping in the day), are chief factors accountable for the creation of Aama. The condition of Aama formation is also exaggerated by mental disorder due to disturbance in Nidra and Brahmcharya. Acharya Sushruta stressed that Nidana is the simple and uttermost basis for a treatment. Prevention is always better than a cure. If we follow proper regimen of Trayopstambha it makes metabolism better, decrease free radical activity in body and reduce the risk of autoimmune diseases.

A temporary cholesterol-rich diet and bacterial extracellular matrix factors favor Salmonella spp. biofilm formation in the cecum.

Asymptomatic chronic carriers occur in approximately 5% of humans infected with Salmonella enterica serovar Typhi (S. Typhi) and represent a critical reservoir for bacterial dissemination. While chronic carriage primarily occurs in the gallbladder (GB) through biofilms on gallstones, additional anatomic sites have been suggested that could also harbor Salmonella. S. Typhimurium, orally infected 129 × 1/SvJ mice were pre-treated with a cholesterol-rich diet as a gallstone model for chronic carriage. We observed S. Typhimurium in feces and the cecum during early and persistent infection. Furthermore, bacterial biofilm-like aggregates were associated with the cecum epithelium at 7 and 21 days post-infection (DPI) in mice on a lithogenic diet (Ld) and correlated with an increase in cecal cholesterol at 21 DPI. Salmonella's extracellular matrix (ECM) was demonstrated as important in colonizing the cecum, as survival and aggregate formation significantly decreased when mice were infected with a quadruple ECM mutant strain. Gallbladder Salmonella counts were low at 36 DPI while cecal Salmonella were high, suggesting that gallbladder colonization was likely not responsible for the high cecal burden. All cecum phenotypes were significantly diminished in mice fed a normal diet (Nd). Finally, we examined the capability of S. Typhi to colonize the cecum and showed S. Typhi in feces and in aggregates in the cecum up to 7 DPI, with slightly higher counts in mice fed a Ld compared to Nd. Our findings suggest that the cecum, particularly under cholesterol-rich conditions, serves as an adaptative niche for Salmonella spp. aggregates/biofilms and is a putative site for long-term infection.IMPORTANCETyphoid fever is a systemic infectious disease triggered by the gastrointestinal dissemination of Salmonella Typhi and Paratyphi in humans. Three to five percent of infected individuals become chronic carriers, a state in which gallstone biofilm formation facilitates spread of the bacteria in feces. Notably, surgical removal of the gallbladder (GB) in some chronic carriers (22%) does not guarantee the elimination of the bacteria, and the rationale for this remains poorly understood. This study is significant as it explores other tissues associated with the chronic carrier state. It highlights not only a cholesterol-rich diet as an important etiological factor for Salmonella colonization but also identifies the cecum as a crucial tissue promoting fecal shedding. Additionally, we determined that biofilm matrix components of Salmonella are key factors contributing to these effects. A greater understanding of these mechanisms will allow the formulation of new therapeutic strategies specifically targeted at preventing typhoid fever dissemination from chronic carriers.

Seasons of Kawasaki Disease during the COVID-19 pandemic.

The incidence of Kawasaki Disease has a peak in the winter months with a trough in late summer/early fall. Environmental/exposure factors have been associated with a time-varying incidence. These factors were altered during the COVID-19 pandemic. The study was performed through the International Kawasaki Disease Registry. Data from patients diagnosed with acute Kawasaki Disease and Multiple Inflammatory Syndrome-Children were obtained. Guideline case definitions were used to confirm site diagnosis. Enrollment was from 1/2020 to 7/2023. The number of patients was plotted over time. The patients/month were tabulated for the anticipated peak Kawasaki Disease season (December-April) and non-peak season (May-November). Data were available for 1975 patients from 11 large North American sites with verified complete data and uninterrupted site reporting. The diagnosis criteria were met for 531 Kawasaki Disease and 907 Multiple Inflammatory Syndrome-Children patients. For Multiple Inflammatory Syndrome-Children there were peaks in January of 2021 and 2022. For Kawasaki Disease, 2020 began (January-March) with a seasonal peak (peak 26, mean 21) with a subsequent fall in the number of cases/month (mean 11). After the onset of the pandemic (April 2020), there was no clear seasonal Kawasaki Disease variation (December-April mean 12 cases/month and May-November mean 10 cases/month). During the pandemic, the prevalence of Kawasaki Disease decreased and the usual seasonality was abolished. This may represent the impact of pandemic public health measures in altering environmental/exposure aetiologic factors contributing to the incidence of Kawasaki Disease.

Perinatal outcomes after surgical treatment of cervical LSIL and conservative treatment of endometrial cancer. A clinical case analysis

This article describes a clinical case of pregnancy management in a patient after surgical treatment of low-grade squamous intraepithelial lesions (LSIL) of the cervix and endometrial cancer. In the structure of female oncological morbidity, precancerous conditions and malignant diseases of the female genital organs occupy leading positions and require the most sparing treatment in women who have not realized reproductive function. The frequency of miscarriage in early pregnancy associated with a history of endometrial cancer, requiring repeated invasive manipulations to assess the effectiveness of treatment, reaches 36–40%, depending on the age of the woman. After surgical interventions on the cervix, regardless of the method of exposure, the frequency of miscarriage significantly increases due to the formation of an organic form of isthmic-cervical insufficiency, which dictates the need for preventive cervical circumcision in a regulated time. In addition, the results of numerous studies also indicate an infectious cause as the main etiological factor in the development and progression of isthmic-cervical insufficiency. Management tactics, obstetric risks, as well as the possibilities of choosing a treatment method are discussed on the basis of the presented clinical case.

Minimally Invasive Distal Metatarsal Osteotomies for Metatarsalgia Treatment: A Review

Introduction: Metatarsalgia is a very common pathology in podiatric consultations, whose main aetiological factor is biomechanical alterations. Given the failure of conservative treatments, minimally invasive osteotomies of the distal metatarsal are becoming more popular, providing comparable results to open surgical techniques and with a lower rate of complications. Objectives: To determine clinical improvement and patient satisfaction after minimally invasive distal metatarsal osteotomy (DMMO) as a surgical treatment for central metatarsalgia at present. Methodology: The databases used for this systematic review were PubMed, Scielo, Cochrane Library, WOS and Scopus. We included articles that studied the efficacy of DMMO for primary metatarsalgia and excluded studies whose patients had more than one pathology or used other surgical techniques. Results: We identified 10 articles, 5 prospective studies, 4 retrospective studies and 1 cross-sectional, non-randomized, analytical study published between 2015 and 2021. The total number of subjects was 366, with a mean age of 61 years. The majority of subjects were women. They presented with symptomatology compatible with primary metatarsalgia for a minimum of 6 months and had failed conservative treatment. Conclusions: DMMO osteotomies for central metatarsals offer excellent post-surgical results for the treatment of central metatarsalgia in the assessment scales (AOFAS, MOXFQ etc.) of the articles analyzed and therefore an evident clinical improvement with benefits in terms of MTF mobility and reduction of surgical time, as well as a high degree of satisfaction in the patients who received this intervention that can be considered as excellent.

Microbial Etiology of Surgical Site Infections, Bacterial Isolates and their Antibiotic Susceptibility Patterns at Trauma University Hospital in Tirana, Albania

Hospital acquired infections in general and specifically surgical site infections increase significantly the morbidity and mortality of post-surgery patients. They are considered the most frequent postoperative complication worldwide, and a major public health burden especially in low income countries. The preventability and the high treatment costs of these complications, sets the focus towards identification of the most frequent etiological factors, in order to decrease the incidence of the phenomenon in different levels. This is a retrospective study carried out from January 1 to December 31, 2023. We analysed the microbiology and antibiotic susceptibility reports of specimens accepted and examined at the laboratory department of the Trauma University Hospital, Tirana. We reported standard operating procedure on direct microscopic examination with gram staining, and the susceptibility patterns reported by millimetre scaling the zone of inhibition of the examined antibiotics disks. We reported 40% negativity rate on the examined specimens. The most frequently isolated microorganisms within the positive results were Acinetobacter Baumannii (25.4%), Staphylococcus Aureus (13.5%), and Enterococcus faecalis (10.32%). The combination of cephalosporins together with aminoglycosides was found to be the most effective antibiotic prophylaxis formulation. Continuous surveillance of bacterial profiles through variable rich, statistically significant additional studies become crucial. The results will help toward better hospital acquired infection prevention and control. Received: 21 August 2024 / Accepted: 10 November 2024 / Published: 3 December 2024

Autopsy-Based Study of Suicidal Deaths Among the Elderly Conducted at Victoria Hospital Mortuary.

Background: Suicide is the act of deliberately killing oneself and it is a significant cause of death in all age groups (1). When comparing the number of attempted and completed suicides, older people have a more significant number of successful suicide than any other age group worldwide (2). 'National Policy on Older Persons'- 1999 defines 'elderly' or ‘senior citizen’ as a person of age 60 years or above (3). NCRB 2020 reported that around 13,126 older people per 100,000 population committed suicide in India (4). Objectives: This study aims to investigate the demographic characteristics, psychological, and etiological factors associated with elderly suicides, and evaluate the methods used by individuals in this age group to end their lives. Methods: A cross-sectional study was conducted at Victoria Hospital Mortuary over 18 months (February 2021 to July 2022). Out of 397 autopsies in the study age group, 67 cases of suicide were included based on the inclusion criteria. Information was collected from police reports, family members, and suicide notes, followed by a detailed analysis of autopsy findings. Results: The study revealed that 77.6% of the victims were male, with the majority falling within the 60-64 age group (40.3%). Hanging was the most common method of suicide (50.7%), followed by poisoning (34.3%). Key contributing factors included psychiatric disorders, predominantly depression (53.73%), chronic physical illness (46.27%), and social isolation or loneliness (32.84%). Conclusion: Elderly suicide is a multifactorial issue, with psychological distress, chronic illness, and social isolation being the primary contributors. Effective prevention strategies should include early mental health interventions and social support systems tailored to the needs of the elderly.

TSPO activation ameliorates maternal immune activation induced PV interneuron deficits via BDNF/TrkB signaling.

Prenatal maternal immune activation (MIA) is an etiological risk factor for schizophrenia in offspring. Recently, parvalbumin (PV) positive interneuron deficits has been considered a critical pathology of many psych-cognitive disorders. Nevertheless, whether and how prenatal MIA affected PV interneuron in offspring remains largely unknown. Here, we aimed to assess the relationship between MIA with PV interneuron deficits in offspring, and explored the underling mechanisms. Mouse model of MIA was induced using lipopolysaccharide (120µg/kg) on gestational day 15-17. Open field, elevated plus maze, Y-Maze and novel object recognition tests were performed and local field potential was recorded on adult male offspring. PV interneuron, Translocator protein 18kDa (TSPO), and BDNF/TrkB signaling were then evaluated. Using TPSO agonist and TrkB antagonist, the function of TSPO on PV interneuron deficits was elucidated. Our results showed that MIA induced cognitive symptoms in the adult male offspring, accompanied by down-regulated PV and TSPO expression as well as decreased theta oscillation. Notably, activating TSPO reversed MIA-induced PV interneuron defects and behavioral abnormalities. Furthermore, specific inhibition of BDNF/TrkB signaling intercepted the protective effect of TSPO activation on PV interneuron deficits. Our results highlight TSPO activation might prevented PV interneuron deficits and behavioral abnormalities after MIA via BDNF/TrkB signaling.

Mapping genetic susceptibility to spontaneous preterm birth: Analysis of Utah pedigrees to find inherited genetic factors.

Spontaneous preterm birth (SPTB) is the leading cause of neonatal morbidity and mortality. It is a final common pathway for multiple etiologies, some of which are well known while others likely remain to be identified. Despite recent advancements in identifying genetic risk factors, the mechanisms of many SPTBs remain poorly understood due to the phenotypic heterogeneity and complexity. Large family-based studies decrease heterogeneity and improve power to identify genetic causes of SPTB. To identify inherited genetic factors in SPTB etiology using large families. Using the Utah Population Database, which links a 4.5 million-person genealogy to state birth certificate and fetal death records, we identified large pedigrees containing multiple women with early SPTB (<34 weeks' gestation) and any SPTB (<37 weeks' gestation). We reviewed birth certificate data to exclude those with maternal and fetal diagnoses associated with iatrogenic preterm birth, resulting in 74 large multiplex pedigrees for early SPTB. Enrolled women with SPTB underwent comprehensive clinical phenotyping with review of primary medical records. Seven pedigrees, each containing at least 3 sampled women with SPTB, were the focus of this genetic study. High-density single-nucleotide polymorphism genotyping was conducted in maternal peripheral blood samples from women in the seven pedigrees. Shared genomic segments analysis was performed to identify genome-wide significant chromosomal regions shared in excess by women with SPTB. We identified two genome-wide significant chromosomal regions. In single-pedigree SGS analysis, a 1.75 Mega base region in chromosome 8 (8q24.23) was shared by 5 out of 6 women with SPTB in a single large pedigree (false positive rate=0.028). In duo-pedigree analysis, a 1.05 Mega base region in the same 8q24.23 locus was identified in a second pedigree (false-positive rate [duo]= 0.0019). The intersecting region at the 8q24.23 locus contains FAM135B (family with sequence similarity 135 member B) and KHDRBS3 (KH RNA binding domain containing, signal transduction associated 3) genes, which have previously been implicated in oncogenesis and ovarian cancer, respectively. Duo-pedigree SPTB analysis also identified a second genome-wide significant 67 kilo base locus in chromosome 12 (12q21.1-q21.2) that was shared by all women with SPTB in two independent pedigrees (false-positive rate [duo] =0.01). The intersecting region at the 12q21.1-q21.2 locus contains CAPS2 (calcyphosine 2) and KCNC2 (potassium voltage-gated channel subfamily C member 2) genes, both implicated in vascular-related complications of pregnancy and preterm labor. Using large SPTB families, we identified shared chromosomal regions (8q24.23 and 12q21.1-q21.2), providing evidence for inherited (segregating) risk loci in SPTB etiology. Further investigation into genes in SPTB etiology, including functional validation may provide avenues for novel therapeutic development and guide efforts for SPTB prevention to prolong pregnancy and improve outcomes.

Prevalence and determinants associated with adolescent idiopathic scoliosis: results of screening in Surakarta, Indonesia

Scoliosis is defined as a vertebral deformity characterized by a lateral deviation of at least 10° with vertebral rotation. Adolescent idiopathic scoliosis is generally found in children aged 10-18 years. Changes in the scoliosis curve are influenced by various etiologic factors including age, sex, growth factors, curve location and biomechanical factors. The study was conducted to determine the prevalence of adolescent iidophatic scoliosis in school students aged 12-15 years in Surakarta city. Physical examination using Adam's forward bending test, scoliometer and risk factor questionnaire. The research subjects were 325 people with an age range of 12-15 years. Research subjects are included in the adolescent idiopathic scoliosis category if the Adam's forward bending test is positive and the scoliometer value is &amp;gt;10°. The highest prevalence of adolescent idiopathic scoliosis was found in school children aged 14 years. The prevalence of adolescent idiopathic scoliosis is higher in female (3.4%) than male students (0.3%). Determining factors that might influence the onset of adolescent idiopathic scoliosis including age, gender, biomechanical factors, habits or lifestyles factors and physical activity.

Therapeutic potential of agents targeting cannabinoid type 2 receptors in organ fibrosis.

The endocannabinoid system has garnered attention as a potential therapeutic target in a range of pathological disorders. Cannabinoid receptors type 2 (CB2) are a class of G protein-coupled receptors responsible for transmitting intracellular signals triggered by both endogenous and exogenous cannabinoids, including those derived from plants (phytocannabinoids) or manufactured synthetically (synthetic cannabinoids). Recent recognition of the role of CB2 receptors in fibrosis has fueled interest in therapeutic targeting of CB2 receptors in fibrosis. Fibrosis is characterized by the alteration of the typical cellular composition within the tissue parenchyma, resulting from exposure to diverse etiological factors. The pivotal function of CB2 agonists has been widely recognized in the regulation of inflammation, fibrogenesis, and various other biological pathologies. The modulation of CB2 receptors, whether by enhancing their expression or activating their function, has the potential to provide benefits in numerous conditions, particularly by avoiding any associated adverse effects on the central nervous system. The sufficient activation of CB2 receptors resulted in the complete suppression of gene expression related to transforming growth factor β1 and its subsequent fibrogenic response. Multiple reports have also indicated the diverse functions that CB2 agonists possess in mitigating chronic inflammation and subsequent fibrosis development in various types of tissues. While currently in the preclinical stage, the advancement of CB2 compounds has garnered significant attention within the realm of drug discovery. This review presents a comprehensive synthesis of various independent experimental studies elucidating the pivotal role of identified natural and synthetic CB2 agonists in the pathophysiology of organ fibrosis, specifically in the cardiac, hepatic, and renal systems.

The Relationship Between Prenatal, Perinatal, and Postnatal Factors and ADHD: The Role of Nutrition, Diet, and Stress.

Attention-Deficit Hyperactive Disorder (ADHD) is a neurobehavioral syndrome affecting children aged 6-17 with symptoms manifesting before age 12. ADHD presents heterogeneously and is associated with various psychiatric disorders. The cause remains elusive, but genetic and environmental factors, brain region maturation delays, and neurotransmitter dysregulation are implicated. Effective treatment requires a multi-disciplinary approach, primarily involving pharmacological and behavioral intervention. Stimulants like methylphenidate and amphetamines are first-line medications, but non-stimulants may be considered for some patients. However, stimulants face challenges related to misuse, dependence, and long-term tolerability issues. The etiology of ADHD involved genetic predisposition, environmental influences, and prenatal, perinatal, and postnatal factors. Prenatal causes encompass maternal diet, alcohol consumption, viral infections, and stress. Postnatal factors include head trauma, meningitis, toxin, nutritional deficiencies, as well as iodine deficiency and hypothyroidism. The gut microbiome's role in ADHD is emerging, influencing neurodevelopment through microbiota-gut-brain axis. Understanding these diverse etiological factors is essential for comprehensive ADHD management.

Hypoalbuminemia is Associated with Higher 90-Day Mortality and Poor Prognosis in Patients with Esophageal Squamous Cell Carcinoma and Liver Cirrhosis Receiving Radiotherapy-Based Therapy.

Liver cirrhosis (LC) is common among patients with esophageal squamous cell carcinoma (ESCC) due to shared etiologic factor, alcohol. For non-metastatic ESCC (nmESCC) patients with cirrhosis, surgery is often contraindicated or associated with high morbidity, therefore radiotherapy-based therapy was commonly applied. This study aims to investigate prognosticators for overall survival (OS) in nmESCC and cirrhotic patients receiving radiotherapy-based therapy. Furthermore, we will also evaluate the predictors for the 90-day mortality rate to reduce avoidable treatment-related toxic effects, and prevent medical waste. Between January 2001 and December 2021, we retrospectively reviewed medical records of 1298 ESCC patients. Total 78 patients with nmESCC and liver cirrhosis identified based on abdominal ultrasonography, computerized tomography, or liver biopsy were enrolled. Clinicopathologic parameters were collected and correlated with OS and 90-day mortality. Univariate analysis revealed that Child-Pugh classification B/C (P<0.001, versus A), radiotherapy alone (P=0.03, versus chemoradiotherapy), prothrombin time (PT) prolonged≧2seconds (P=0.024), albumin≦3.5g/dl (P<0.001), controlled/refractory ascites (P=0.01, versus none of ascites), and total bilirubin≧1.5mg/dl (P=0.004) were significantly associated with inferior OS. In multivariate analyses, albumin≦3.5g/dl (P=0.001, odds ratio (OR): 2.500) and total bilirubin≧1.5mg/dl (P=0.019, OR: 2.012) were independent adverse prognosticators. The 90-day mortality in these 78 patients receiving radiotherapy-based therapy was 10.3% (n=8), including ESCC progression in 4 patients, liver failure in 1 patient, and others in 3. Clinical 8th AmericanJoint Committee on Cancer (AJCC) stage IVA (P=0.02), clinical T classification T3/4 (P=0.049), PT prolonged≧4seconds (P=0.009), and albumin≦3.5g/dl (P=0.027) were significantly correlated with higher 90-day mortality. Logistic model showed albumin≦3.5g/dl (P=0.015, OR: 16.129) and clinical 8th AJCC stage IVA (P=0.012, OR: 17.544) were independently correlated with higher 90-day mortality. Hypoalbuminemia is associated with higher 90-day mortality and poor prognosis in nmESCC and liver cirrhosis patients receiving radiotherapy-based therapy.

Swallowing and Aspiration: How to Evaluate and Treat Swallowing Disorders Associated with Aspiration Pneumonia in Older Persons.

Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction, and oral colonization by respiratory pathogens. Incidence is estimated at between 5 and 15% of cases of CAP, but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society, that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for health care professionals, new artificial intelligence (AI)-based screening tools for OD combined with validated clinical methods such as the volume-viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP.

Chronic Heart Failure: Focus on Differences Between Men and Women

This review focuses on the sex-related differences of patients in etiological factors, clinical picture, and objective laboratory and instrumental signs of heart failure. The authors performed an analysis of the effectiveness of drug and non-drug treatments depending on the gender of patients with low and preserved left ventricular ejection fraction, which should improve the quality of medical care and outcomes in patients with heart failure.

Aesthetic crown lengthening in gingival enlargement patients with orthodontic treatment: A case report

Introduction: The orthodontic treatment process that is carried out can cause changes in the soft tissue and hard tissue of the tooth support and the most common is the enlargement of the gingiva. One of the managements in the case of gingival enlargement is crown lengthening, which is carried out by taking gingival tissue with or without bone reduction to further expose the tooth structure so that a better ratio of dental crown and gingiva is obtained. The purpose of this article is to describe the crown lengthening procedure with bone reduction to correct excessive gingival display in patients with orthodontic treatment on the anterior teeth of the upper jaw Case Report: A 19-year-old female patient came to the Periodontology Specialist Poly on a referral from the Dental Orthodontic Specialist of RSGM Universitas Airlangga with complaints that the upper front teeth looked shorter. The patient does not have problems with the periodontal tissue and has no history of systemic diseases such as diabetes, high blood pressure, and no history of allergy to medications. Case management: After the analysis is carried out on the periodontal tissue, the therapy option is in the form of crown lengthening with bone reduction for the treatment of the case. Conclusion: Determining etiological factors and proper examination is very important to determine a crown lengthening action plan as the elimination of gingival enlargement so that it can improve aesthetic appearance.

Frenectomy for supporting diastema closure correction in orthodontic patients

Introduction: The maxillary frenulum can cause aesthetic problems or jeopardize orthodontic results in cases of central diastema, causing relapse after treatment. One of the etiologic factors of central diastema persistence is an aberrant frenulum. The most common way to diagnose frenulum attachment is with the blanch test. One of the treatments for aberrant frenulum is frenectomy. Frenectomy can reduce the risk of relapse from central diastema closure. The purpose of this case report is to describe the stages of frenectomy in a case of maxillary central diastema. Case report: A 24-year-old woman came to the Periodontics Specialist Clinic due to a referral from the Department of Orthodontic, Dental Hospital Universitas Airlangga with complaints of loose maxillary front teeth and planned to be treated using fixed orthodontic devices at Department Orthodontic. The blanching test examination showed that the labial frenulum was in the high frenulum category. Case management: Frenectomy was performed using a scalpel. After extraoral and intraoral asepsis, infiltration anesthesia was performed on the labial and palatal sides of tooth 11,21. Clamp the maxillary labial frenulum using a hemostat and then incise the frenulum using blade no 15c in a V shape, then incise the frenulum attachment on the interdental to the palatal region with an elliptical incision. Interrupted suturing using Nylon thread size 4.0. The surgical area was closed using a periodontal pack. Suturing was removed on day 14. Follow-up at 19 months showed no diastema in the anterior maxilla, the patient wore a retainer in the maxilla and a fixed retainer in the mandible. There were no further complaints after the treatment. Conclusion: Frenectomy before orthodontic treatment helps accelerate the treatment progress to correct the central diastema.

Anti-infective drugs as etiologic factors for Stevens–Johnson syndrome and toxic epidermal necrolysis according to the Russian database of spontaneous reports

Relevance. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are serious adverse drug reactions (ADRs) associated with drug use. Knowledge of drug triggers is important for ADR prevention.Objective. To study the structure of anti-infective drugs that cause the development of SJS and TEN.Methods. We studied spontaneous reports (SRs) submitted to the Russian National Pharmacovigilance database from 01.04.2019 to 31.12.2023. SRs about the development of SJS or TEN were included. Suspected drugs in group J according to the ATC classification were analyzed.Results. Among the 170 included SRs, anti-infectives were noted as suspects in 69, and the total number of drugs was 103. 75 drugs were antibacterial (beta-lactams were leading, n = 46), and 21 were antiviral agents.Conclusion. In terms of the structure of anti-infective drug triggers, 72.8% were antibacterial drugs and 20.4% were antiviral agents.

Dental Practitioners’ Knowledge and Attitudes Toward the Etiology, Diagnosis, and Treatment of Peri-Implantitis

The objective of this study was to assess the level of knowledge and attitude about the etiology, diagnosis, and management of peri-implantitis among dental practitioners. Methods: An online cross-sectional study on 303 dentists in Saudi Arabia was conducted. A closed-ended survey consisting of 28 questions was designed. Three sections were created, i.e., (1) participants’ characteristics; (2) knowledge of peri-implantitis etiology, risk factors, diagnosis, and complications; and (3) the use of antibiotics to manage peri-implantitis and methods used for diagnosis and treatment. The data were analyzed using mean and percentages. Results: A total of 303 dentists participated in this study with a 78.8% response rate, comprising 80% general dentists and 20% specialists. The majority of dentists demonstrated knowledge about peri-implantitis, with 85.5% identifying bacterial plaque as an etiologic factor and 83.8% recognizing it as an inflammatory reaction. Regarding risk factors, 88.1% identified smoking and 86.1% recognized periodontitis as contributors to peri-implant disease development. In terms of clinical decision making, 63% of participants considered implant mobility as a definitive indication for implant removal, and more than half reported using crater-like bone defects surrounding implants as a diagnostic criterion for peri-implantitis. For antimicrobial therapy, amoxicillin alone (30%) was the most commonly prescribed antibiotic, followed by the combination of amoxicillin with metronidazole (29%). Despite these treatment approaches, it is important to note that currently there are no established, predictable protocols for treating any phase of peri-implant disease. Conclusion: While participating dentists demonstrated a strong understanding of peri-implantitis etiology and risk factors, particularly regarding bacterial plaque and smoking as major contributors, there was considerable variation in antibiotic selection and usage patterns. These findings suggest the need for standardized guidelines and further research to establish evidence-based protocols for managing peri-implant diseases.