Treatment Modalities Research Articles

Updates in the care and management of children and adolescents with systemic lupus erythematosus.

This narrative review offers an update of the most important recent articles published in the previous year of childhood-onset systemic lupus erythematosus (cSLE), focusing on care and management. Age-related disparities may play a significant role in the clinical and laboratory characteristics of cSLE, as well as its performance in distinct classification criteria. Monogenic lupus is associated with higher disease damage scores and mortality rate compared to sporadic cSLE. Adolescent face unique challenges, with comorbid psychiatric diagnosis, low resilience and nonadherence posing relevant challenges. A recent international task force has outlined pivotal principles and points-to-consider for treat-to-target (T2T) in cSLE patients. While the past year did yield new randomized controlled trial for cSLE treatment, publications focused on broader management strategies, including the impact of ultraviolet radiation exposure, immunization, and strict blood pressure control. Additionally, case reports and series have evaluated the efficacy/safety profiles of both available and emerging treatments. Current studies highlighted the various facets of cSLE, epidemiology, clinical, laboratory, classification criteria, adolescent issues, prognosis, surveillance, T2T approach and drug management. Despite notable progress, the scarcity of randomized trials emphasizes the need to delineate safer and more efficacious treatment modalities in cSLE.

Mpox in people with HIV: A narrative review.

The 2022 global mpox outbreak disproportionately impacted people living with HIV. This review explores recent evidence on mpox in this group, focusing on clinical presentation, complications, treatment modalities and vaccine strategies. Recent studies have suggested that people with HIV diagnosed with mpox have a greater risk of proctitis and hospitalization compared with people without HIV. In addition, those with advanced immunosuppression face an elevated risk of severe mpox infection, which can lead to mortality. Comprehensive and prompt supportive care using antiretrovirals and mpox antivirals is crucial in this group. Although results from randomized clinical trials are still forthcoming, recent studies suggest that early initiation of tecovirimat can prevent disease progression in people with HIV. The non-replicative attenuated smallpox vaccine is well tolerated and effective in preventing monkeypox virus infections in people with HIV. Further studies are needed regarding long-term vaccine effectiveness for this population. Evaluating the risk of severe mpox in people living with HIV requires assessing the level of immune suppression and viral control. Universal access to vaccination is imperative to prevent the resurgence of future outbreaks.

Emerging trends in urinary tract infection pathogens: Insights from K. oxytoca and M. morganii in Indian settings

Urinary tract infections (UTIs) are a significant global health concern affecting millions annually. In India, UTIs linked to various bacterial pathogens, particularly and present a formidable challenge. This study aimed to evaluate the occurrence of these bacteria in urine samples obtained from UTI patients in Indian settings. Our investigation identified a notable proportion of UTIs associated with and highlighting the necessity for customized therapeutic approaches. Additionally, we conducted antibiotic susceptibility testing to guide appropriate antibiotic selection. Our findings revealed that 90% of isolates exhibiting additional resistance to Azithromycin (AZK). These results emphasize the importance of judicious antibiotic use and continuous monitoring of antibiotic resistance in UTI-causing pathogens in Indian healthcare settings. This study contributes to UTI management strategies and the development of tailored treatment modalities for the Indian population.

Striking the Balance with a PD-L1×4-1BB Bispecific Antibody.

Antibody-based immune checkpoint blockade therapy has revolutionized the field of cancer immunotherapy, yet its efficacy remains limited in immunologically cold tumors. Combining checkpoint inhibitors with costimulatory agonists improves tumoricidal activity of T cells but also can lead to off-target hepatotoxicity. Although bispecific antibodies confer tumor selectivity to alleviate undesirable adverse effects, toxicity concerns persist with increased dosing. In this issue of Cancer Research, Yuwen and colleagues introduce ATG-101, a tetravalent PD-L1×4-1BB bispecific antibody with high programmed death ligand 1 (PD-L1) affinity and low 4-1BB affinity, aiming to mitigate hepatotoxicity. ATG-101 demonstrates PD-L1-dependent 4-1BB activation, leading to selective T-cell activation within the tumor microenvironment. ATG-101 exhibits potent antitumor activity, even in large, immunologically cold, and monotherapy-resistant tumor models. Single-cell RNA sequencing reveals significant shifts of immune cell populations in the tumor microenvironment from protumor to antitumor phenotypes following ATG-101 treatment. In cynomolgus monkeys, no serious cytokine storm and hepatotoxicity are observed after ATG-101 treatment, indicating a broad therapeutic window for ATG-101 in cancer treatment. This study highlights the potential of tetravalent bispecific antibodies in cancer immunotherapy, with implications for various antibody-based treatment modalities across different fields. See related article by Yuwen et al., p. 1680.

A systematic review on prosthodontic rehabilitation of hemimandibulectomy patients

To restore oral function after tumor excision, practitioners must undertake the enormous challenge of restoring hemimandibulectomy deficits. Depending on the type and extent of mandibular reconstruction (Cantor-Curtis classification), there are many prosthetic treatment options available for the rehabilitation of acquired hemimandibulectomy abnormalities. The objective of this systematic study is to evaluate the range of prosthodontic rehabilitation techniques in relation to the kind of repair and severity of mandibular surgical abnormalities. The databases incorporated for literature search were Google Scholar and Medline (PubMed). Relevant search terms for hemimandibulectomy and reconstruction with prosthetic rehabilitation were used. Two reviewers independently assessed the articles using eligibility criteria; published case reports and case series in the English language and depicting prosthodontic treatment modality of patients greater than 13 years were included. A total of 212 records were identified from the database search of which 29 duplicates were removed.The remaining articles were assessed for eligibility, and 50 articles (comprising 50 cases) were finally included in the study. This review identified a number of prosthetic options, including some novel prosthetic techniques, guiding flange, twin occlusion, palatal ramp, conventional to hybrid partial and complete dentures, and implant-supported prosthesis.The prosthetic options covered in this review included implant-supported prosthesis, guide flange, dual occlusion, palatal ramp, conventional, hybrid, and full dentures, as well as a few cutting-edge prosthetic techniques.As they plan and manage sequential therapy for hemimandibulectomy cases in their daily practice, practitioners and prosthodontists will find this helpful.

Prospective Outcomes of Microlaryngoscopy Versus Office Laser Photoangiolysis for Vocal Fold Polyps.

The objective of this study is to compare treatment outcomes for vocal fold polyps (VFPs) between operating room microlaryngoscopy and office-based photoangiolysis with the potassium titanyl phosphate (KTP) laser. Prospective nonrandomized cohort study of patients with VFPs undergoing microlaryngoscopy ("OR group") or KTP laser photoangiolysis ("KTP group"). Voice outcomes (patient-reported outcome measures [Voice Handicap Index-10 (VHI-10) and Singing VHI-10 (SVHI-10)], auditory-perceptual measures [Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)], videostroboscopic characteristics [Voice-Vibratory Assessment of Laryngeal Imaging (VALI)], and acoustic and aerodynamic measures) were performed at baseline and regular intervals after intervention. Forty-four subjects (17 OR group, 27 KTP group) with VFPs were enrolled. Mean VHI-10 significantly improved from baseline to each follow-up interval in both groups, except for the 1-2-week interval in the OR group. Mean SVHI-10 improved for both groups at some intervals. Growth curve models and time-to-event analyses for patient-reported outcomes did not differ between groups. There were significant improvements in all categories of auditory-perceptual voice quality and some categories of videostroboscopic characteristics in both groups. No significant trends were identified in acoustic and aerodynamic measures. Improvements in most outcomes did not significantly differ between groups or based on polyp size. There were no major complications. Significant improvements in patient-reported voice outcomes measures, auditory-perceptual voice evaluation, and videostroboscopic characteristics occur following surgical treatment of vocal fold polyps with either microlaryngoscopy or office-based KTP laser. Long-term voice outcomes do not significantly differ between treatment modalities. Level 3 Laryngoscope, 2024.

Preferences of physicians for treatment-related toxicity vs. recurrence in melanoma (GERMELATOX-A): the doctors’ perspective

IntroductionAdjuvant treatment with immune checkpoint inhibitors, such as PD1-antibodies (ICI) ± CTLA4-antibodies (cICI) or targeted therapy with BRAF/MEK inhibitors (TT), has shown a significant improvement in disease-free survival (DFS) for high-risk melanoma patients. However, due to specific side effects, the choice of treatment is often influenced by the risk of toxicity. Therefore, the role of physicians in treatment decisions of patients is crucial. This study investigated for the first time in a multicenter setting the attitudes and preferences of dermatooncologists in Germany and Switzerland regarding adjuvant treatment with (c)ICI and TT.MethodsIn the GERMELATOX-A study, 108 physicians (median age: 32 yrs, 67.6% female) from 11 skin cancer centers were surveyed to rate typical side effect scenarios of (c)ICI and TT treatments and then compared to patients’ ratings evaluated in a previous analysis from the same centers. The scenarios described mild-to-moderate or severe toxicity and included melanoma relapse leading to death. The physicians were asked about the level of side effects they would tolerate in exchange for a reduction in melanoma relapse and an increase in survival at 5 years.ResultsThe preferences of physicians and patients revealed significant differences regarding adjuvant melanoma treatment with (c)ICI and TT (p < 0.05). Compared to patients, physicians tend to value a melanoma relapse less severe, according to a visual analog scale. They were also less threatened by all scenarios of side effects during adjuvant treatment with (c)ICI or TT, compared to patients. Physicians required lower risk reductions for disease-free survival (DFS) and overall survival (OS) for both ICI and TT and their drug-related side effects to accept these treatments. In case of severe side effects, physicians required similar 5-year DFS rates for ICI and TT (60–65%), while patients needed a 15% improvement of 5-year DFS for ICI compared to TT (80%/65%). For survival, physicians expected an OS improvement of + 10% for all three treatment modalities, whereas patients required a higher increase: + 18–22% for ICI and + 15% for TT.ConclusionOur study highlights the importance of understanding the patient’s perspective and a potential difference to the doctor’s view when making decisions about adjuvant melanoma treatment with (c)ICI and TT, especially as these treatments are increasingly being implemented in earlier stages.

Surgical Treatment of Temporomandibular Joint Ankylosis: our experience with 36 cases.

To evaluate and compare outcomes of patients with temporomandibular joint ankylosis (TMJA) treated by gap arthroplasty, costochondral graft, and total alloplastic joint reconstruction. A retrospective cohort study reviewed and analyzed data from patients with TMJA from January 1, 2009 to December 31, 2019, at the Maxillofacial and Oral Surgery Department, University of the Witwatersrand. Patients with TMJA were treated either with gap arthroplasty, costochondral graft, or total alloplastic joint reconstruction. Data collected included age, sex, etiology of ankylosis, sides involved, preoperation and postoperation mouth opening (MO), treatment type, complications, and revision surgery. Patients were followed up for at least 18 months after the surgical procedure. Comparison of means across the treatment groups was analyzed using paired t tests or analysis of variance test. A P value of less than 0.05 was considered statistically significant. The study sample comprised of 36 patients [bilateral, n=22; unilateral, n=14 (21 male, 15 female)]. Trauma was the most common etiology (n=27, 75%), followed by chronic infections (n=4, 11.11%) and juvenile arthritis (n=3, 8.3%). A paired t test revealed no statistical significance between treatment modality and postoperative MO and complications over 18 months (P=0.5316 and P=0.426, respectively). The mean MO increased from 4 to 28mm. Reankylosis was the most common complication (n=5). All 3 treatment options yield acceptable outcomes in patients with TMJA. Irrespective of surgical technique, early postoperative exercises, active physiotherapy, and follow-up are imperative for successful rehabilitation and prevention of reankylosis.

Pharmacotherapies for the Treatment of Progressive Supranuclear Palsy: A Narrative Review.

Progressive supranuclear palsy (PSP) is a neurodegenerative disorder resulting from the deposition of misfolded and neurotoxic forms of tau protein in specific areas of the midbrain, basal ganglia, and cortex. It is one of the most representative forms of tauopathy. PSP presents in several different phenotypic variations and is often accompanied by the development of concurrent neurodegenerative disorders. PSP is universally fatal, and effective disease-modifying therapies for PSP have not yet been identified. Several tau-targeting treatment modalities, including vaccines, monoclonal antibodies, and microtubule-stabilizing agents, have been investigated and have had no efficacy. The need to treat PSP and other tauopathies is critical, and many clinical trials investigating tau-targeted treatments are underway. In this review, the PubMed database was queried to collect information about preclinical and clinical research on PSP treatment. Additionally, the US National Library of Medicine's ClinicalTrials.gov website was queried to identify past and ongoing clinical trials relevant to PSP treatment. This narrative review summarizes our findings regarding these reports, which include potential disease-modifying drug trials, modifiable risk factor management, and symptom treatments.

The Discovery of Oral Cancer Prognostic Factor Ranking Using Association Rule Mining.

A 5-year survival rate is a predictor for the assessment of oral cancer prognosis. The purpose of this study is to analyze oral cancer data to discover and rank the prognostic factors associated with oral cancer 5-year survival using the association rule mining (ARM) technique. This study is a retrospective analysis of 897 oral cancer patients from a regional cancer center between 2011 and 2017. The 5-year survival rate was assessed. The multivariable Cox proportional hazards analysis was performed to determine prognostic factors. ARM was applied to clinicopathologic and treatment modalities data to identify and rank the prognostic factors associated with oral cancer 5-year survival. The 5-year overall survival rate was 35.1%. Multivariable Cox proportional hazards analysis showed that tumor (T) stage, lymph node metastasis, surgical margin, extranodal extension, recurrence, and distant metastasis of tumor were significantly associated with overall survival rate (p < 0.05). The top associated death within 5 years rule was positive extranodal extension, followed by positive perineural and lymphovascular invasion, with confidence levels of 0.808, 0.808, and 0.804, respectively. This study has shown that extranodal extension, and perineural and lymphovascular invasion were the top ranking and major deadly prognostic factors affecting the 5-year survival of oral cancer.

Influence of Pathophysiological Patterns of Coronary Artery Disease on Immediate Percutaneous Coronary Intervention Outcomes.

Diffuse coronary artery disease (CAD) impacts the safety and efficacy of percutaneous coronary intervention (PCI). Pathophysiological CAD patterns can be quantified using fractional flow reserve (FFR) pullbacks incorporating the pullback pressure gradient (PPG) calculation. This study aimed to establish the capacity of PPG to predict optimal revascularisation and procedural outcomes. This prospective, investigator-initiated, single-arm, multicentre study enrolled patients with at least one epicardial lesion with an FFR ≤ 0.80 scheduled for PCI. Manual FFR pullbacks were employed to calculate PPG. The primary outcome of optimal revascularisation was defined as a post-PCI FFR ≥ 0.88. 993 patients with 1044 vessels were included. The mean FFR was 0.68 ± 0.12, PPG 0.62 ± 0.17, and post-PCI FFR 0.87 ± 0.07. PPG was significantly correlated with the change in FFR after PCI (r=0.65, 95% CI 0.61-0.69, p<0.001) and demonstrated excellent predicted capacity for optimal revascularisation (AUC 0.82, 95% CI 0.79-0.84, p<0.001). Conversely, FFR alone did not predict revascularisation outcomes (AUC 0.54, 95% CI 0.50-0.57). PPG influenced treatment decisions in 14% of patients, redirecting them from PCI to alternative treatment modalities. Periprocedural myocardial infarction occurred more frequently in patients with low PPG (<0.62) compared to those with focal disease (OR 1.71, 95% CI: 1.00-2.97). Pathophysiological CAD patterns distinctly affect the safety and effectiveness of PCI. The PPG showed an excellent predictive capacity for optimal revascularisation and demonstrated added value compared to a FFR measurement.

Selective internal radiation therapy segmentectomy: A new minimally invasive curative option for primary liver malignancies?

Transarterial radioembolization or selective internal radiation therapy (SIRT) has emerged as a minimally invasive approach for the treatment of tumors. This percutaneous technique involves the local, intra-arterial delivery of radioactive microspheres directly into the tumor. Historically employed as a palliative measure for liver malignancies, SIRT has gained traction over the past decade as a potential curative option, mirroring the increasing role of radiation segmentectomy. The latest update of the BCLC hepatocellular carcinoma guidelines recognizes SIRT as an effective treatment modality comparable to other local ablative methods, particularly well-suited for patients where surgical resection or ablation is not feasible. Radiation segmentectomy is a more selective approach, aiming to deliver high-dose radiation to one to three specific hepatic segments, while minimizing damage to surrounding healthy tissue. Future research efforts in radiation segmentectomy should prioritize optimizing radiation dosimetry and refining the technique for super-selective administration of radiospheres within the designated hepatic segments.

Early Non-Surgical Treatment For Microtia Types 1 and 2.

Esthetic concerns and psychosocial distress often accompany auricular deformities and malformations in both children and their parents. Approximately 30% of newborns are affected by auricular anomalies, with 15% to 20% resulting in permanent defects. While surgical intervention is typically considered the gold standard for malformations, a non-surgical approach, such as splinting, molding, or other non-invasive techniques, can effectively address deformations if promptly administered by a specialist. Microtia, classified into 4 types, presents challenges ranging from fundamental structural anomalies in types 1 and 2 to severe defects in type 3 and complete absence of the external ear in type 4 (anotia). This study introduces a novel non-invasive treatment modality for microtia types 1 and 2. The cohort consisted of 5 newborns treated for microtia types 1 or 2 between 2022 and 2023. Utilizing the EarWell system, treatment was initiated before 3 weeks of age (mean age: 2 weeks), with an average treatment duration of 6.6 weeks, supplemented by molding treatment as needed. Minor adverse effects, such as simple dermatitis, were observed in 2 patients. All parents expressed high satisfaction with the esthetic outcomes, with 60% reporting extreme satisfaction. The prompt initiation of the treatment protocol for microtia types 1 and 2 led to outstanding and timely outcomes in infants, enhancing the quality of life for both parents and their children. Early intervention for subsequent treatment may improve the condition and, in certain cases, serve as a satisfactory alternative for parents hesitant about further surgical intervention for their children.

Iatrogenic open humeral shaft fractures following functional bracing.

The treatment of closed humeral shaft fractures tends to be successful with functional bracing. Treatment failure due to iatrogenic conversion to an open fracture has not been described in the literature. We present a case series of patients that experienced open humeral shaft fractures after initially being treated with functional bracing for closed humeral shaft fractures and describe what factors are associated with this complication. This was a retrospective case series performed at three level 1 trauma centers across North America. All nonoperatively treated humeral shaft fractures were reviewed from 2001 to 2023. Patients were included if they sustained a humeral shaft fracture, > 18 years old, were initially treated non-operatively with functional bracing which subsequently converted to an open fracture. Eight patients met inclusion criteria. All included patients were eventually treated with irrigation, debridement, and open reduction and internal fixation. Outcomes assessed included mortality rate, time until the fracture converted from closed to open, need for further surgery, and bony union. Descriptive statistics were used in analysis. The eight included patients on average were 65 ± 21.4 years old and had a body mass index (BMI) of 25.6 ± 5.2. Six patients were initially injured due to a fall. Time until the fractures became open on average was 5.2 ± 3.6 weeks. Three patients (37.5%) died within 1.8 ± 0.6 years after initial injury. The average Charlson Comorbidity Index (CCI) score was 4.5 ± 3.4. Three patients (37.5%) had dementia. Common characteristics among this cohort included a history of visual disturbances (50.0%), cerebrovascular accident (50.0%), smoking (50.0%), and alcohol abuse (50.0%). Conversion from a closed to open humeral shaft fracture after functional bracing is a potentially devastating complication. Physicians should be especially cognizant of patients with a low BMI, history of falling or visual disturbance, dementia, age ≥ 65, decreased sensorimotor protection, and significant smoking or alcohol history when choosing to use functional bracing as the final treatment modality. IV.

Unilateral gamma knife thalamotomy for tremor safety and efficacy in multimodal assessment: a prospective case-control study with two-year follow-up.

Unilateral gamma knife thalamotomy (GKT) is a treatment option for pharmacoresistant tremor of various aetiologies. There have been to date no randomised controlled trials performed to assess its safety and efficacy. Our aim was to summarise a two-year multimodal observation of patients with tremor caused by Parkinson's Disease (PD) or essential tremor (ET). 23 patients with PD (n = 12) or ET (n = 11) were included. They underwent assessments before, V0 (n = 23), and 12 months, V12 (n = 23), and 24 months, V24 (n = 15), after unilateral GKT. Patients were assessed with psychological tests and acoustic voice analysis. Tremor assessment was performed with a digitising table using the Fahn-Tolosa-Marin rating scale (FTMRS). The Unified Parkinson's Disease rating scale part III (UPDRS-III) was also used in the PD group. Gait and balance was assessed using clinical tests, stabilometric platform, and treadmill. No side effects were observed in a two-year follow-up. There was no notable deterioration observed in the patients' psychological evaluation, speech, or assessment of gait and balance. The scores were significantly lower (p = 0.01) in parts A and B of FTMRS one year after GKT. In post hoc analysis, the scores did not differ significantly between V0 and V24. In FTMRS part C (activities of daily living), no significant change was observed. There was no significant difference in total UPDRS part III score or in score of UPDRS part III domains 3 and 4 ('tremor at rest' and 'action and postural tremor of hands') between measurements. UGKT may be a safe treatment modality if performed in an experienced centre. Tremor reduction may diminish over time, and UGKT did not lead to cognitive, gait or speech deterioration in a long-term observation.

The health-related quality of life of early-onset colorectal cancer patients: an Australian cross-sectional study.

Early-onset colorectal cancer (EOCRC) patients are more likely to have advanced disease and undergo more aggressive treatment modalities. However, current literature investigating the health-related quality of life (HRQoL) of EOCRC patients is scarce. This study aimed to determine the HRQoL of an Australian cohort of EOCRC patients including a subset who underwent pelvic exenteration (PE) or cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). A cross-sectional study of EOCRC patients treated at the Royal Prince Alfred Hospital, Sydney Australia was performed. Patients were divided into groups based on the time interval from their index operation: ≤2 years and >2 years. HRQoL was evaluated using the SF-36v2 questionnaire. A total of 50 patients were included. For patients ≤2 years from surgery, the median physical component summary (PCS) and mental health component summary (MCS) scores were 53.3 (36.4-58.9) and 47.3 (37.5-55.7). In the >2 years group, the median PCS and MCS scores were 50.6 (43.3-57.7) and 50.2 (39.04-56.2), respectively. Stage I (vs. stage II) disease and emergency (vs. elective) surgery conferred poorer PCS scores in patients ≤2 years from surgery. No other variables impacted PCS or MCS scores in EOCRC patients in either group. HRQoL of EOCRC patients was equivocal to the Australian population. Having an earlier stage of diagnosis and emergency index operation was associated with poorer levels of physical functioning in patients ≤2 years from surgery. However, because of the limitations of this study, these findings require validation in future large-scale prospective research.

Guideline for the management of symptomatic and asymptomatic internal carotid artery stenosis

Stenoses of the internal carotid artery (ICA) with a≥ 50% degree of stenosis are common in the German population with aprevalence of approx. 4.2%. Furthermore, about 15% of ischemic strokes are due to stenosis or occlusion of the ICA. There are currently three approaches to the treatment of ICA stenoses: conventional therapy, endovascular treatment and surgical treatment. Summary of the S3guideline on the diagnosis, treatment and follow-up of extracranial carotid stenosis from 3February2020. Color-coded duplex sonography, computed tomography (CT) angiography and magnetic resonance (MR) angiography and, in exceptional cases, diagnostic subtraction angiography can be used to diagnose ICA stenoses, including the stenosis grade. The classification is into symptomatic and asymptomatic ICA stenoses. ICA stenoses can be treated conservatively, endovascularly with stenting or surgically by carotid endarterectomy. Invasive treatment should be carried out under inpatient conditions, whereby the hospital stay should be kept as short as possible. Color-coded duplex sonography should be performed regularly before discharge and at regular intervals thereafter to detect recurrent stenosis at an early stage and, if necessary, to initiate further invasive therapy. When choosing the treatment modality, particular attention must be paid to whether the stenosis is symptomatic or asymptomatic and the degree of stenosis. The S3guideline on the diagnosis, treatment and follow-up of extracranial carotid stenosis from 3February2020 provides guidance here.

Profile and Prevalence of Oral and Maxillofacial Diseases Among Armed Forces Personnel and Their Families in Military Dental Centre, Cumilla

Background: Oral and maxillofacial diseases encompass a wide range of conditions in and around oral cavity and in maxillofacial region. It includes maxillofacial trauma, cyst and tumour of jaw bones, conditions involving impacted wisdom teeth, oral premalignant and malignant lesions, fascial space infection around maxillofacial region, temporomandibular joint disorder, dental implantology, salivary gland disorder and congenital defects of jaw bones. Maxillofacial region is more vulnerable to sustain injuries in the battlefield. In peace time, various maxillofacial diseases reduce the overall performances of the troops. The aim of this study is to delineate rank wise distribution of armed forces personnel reported with maxillofacial diseases, gender distribution, types of maxillofacial diseases, different types of surgical procedures performed and types of anesthesia used. Methods: A descriptive cross-sectional study was conducted to assess the prevalence of maxillofacial diseases among the armed forces personnel and their entitled family members during the period of 1st January 2019 to 31st December 2019 in Military Dental Centre, Cumilla. Purposive sampling technique and semi structured questionnaire was used to include the patients in this study.Data were analyzed by using Statistical Packages for Social Sciences (SPSS) version 25. Results: A total of 170 cases were evaluated and treated. Male patients were 110(65%) and female were 60(35%). Among the military personnel numbers of sainik (privates) were highest 32(35%). Impacted wisdom teeth cases were mostly found 80(47%). In case of impacted teeth mesio angular impactions were most 35(35%). In case of maxillofacial pathological conditions cystic lesions were most in number 22(39%) (n=56). Maxillofacial soft tissue laceration cases were highest 05(29%) (n=17) among all trauma patients. Surgical extraction of wisdom teeth were mostly performed surgery 80(59%) (n=138). In regards to administration of anesthesia, 128(93%) cases were performed under local anesthesia and 10(7%) were under general anesthesia. Conclusion: The present study imparts valuable perception about the types and prevalence of maxillofacial diseases and the treatment modalities among the armed forces personnel and their families in Cumilla area. Bangladesh Armed Forces Med J Vol 56 No (2) December 2023, pp 24-30

Congenital Disseminated Pyogenic Granuloma: A Case With Numerous Mucocutaneous and Visceral Lesions

Abstract Congenital disseminated pyogenic granuloma (CDPG) is characterized by eruptive disseminated or localized lesions, which may arise spontaneously or secondary to predisposing factors. Even rarer is the occurrence of CDPG with numerous lesions affecting variable organs, which develop during the fetal period. This report describes the case of a 32-week-old fetus presenting with severe hydrocephalus and vascular intracranial and right lung masses on magnetic resonance imaging. Preterm labor occurred at the 32nd week due to preterm premature rupture of membranes, and the newborn died due to cardiac dysfunction within 2 hours postpartum. The subsequent autopsy revealed multiple violaceous to dark red papules, nodules, pedunculated and un-pedunculated mucocutaneous masses, as well as two brain lesions, a lung lesion, a thoracic wall intramuscular mass, and a pyloric mass. Microscopic examination and immunohistochemical evaluation for glucose transporter 1 (GLUT1) confirmed the diagnosis of CDPG. CDPG represents a rare condition with an elusive etiology and limited reports in the literature. Differential diagnosis from multifocal infantile hemangioma, based on GLUT1 negativity of CDPG, is imperative due to differing clinical course and treatment modalities. This report underscores a severe case of CDPG characterized by preterm labor and demise shortly after delivery, notable for its extensive involvement across multiple organs, including the brain, lung, intestine, musculoskeletal system, mucosal, and numerous cutaneous sites.

The Neuroblastoma Microenvironment, Heterogeneity and Immunotherapeutic Approaches

Neuroblastoma is a peripheral nervous system tumor that almost exclusively occurs in young children. Although intensified treatment modalities have led to increased patient survival, the prognosis for patients with high-risk disease is still around 50%, signifying neuroblastoma as a leading cause of cancer-related deaths in children. Neuroblastoma is an embryonal tumor and is shaped by its origin from cells within the neural crest. Hence, neuroblastoma usually presents with a low mutational burden and is, in the majority of cases, driven by epigenetically deregulated transcription networks. The recent development of Omic techniques has given us detailed knowledge of neuroblastoma evolution, heterogeneity, and plasticity, as well as intra- and intercellular molecular communication networks within the neuroblastoma microenvironment. Here, we discuss the potential of these recent discoveries with emphasis on new treatment modalities, including immunotherapies which hold promise for better future treatment regimens.