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This study examined the pretreatment and post treatment dental arch width changes between the extraction and non-extraction cases in Angle’s class I patients. Sixty pre-treatment and post-treatment dental casts from 30 extractions and 30 non-extractions participants were selected for the study. The inter-canine and inter-molar maxillary arch width were measured by Vernier gauge caliper. An unpaired t-test was performed to evaluate the arch width changes between extraction and non-extraction groups. The results showed that inter-molar and inter-canine maxillary arch widths in the non-extraction group were slightly higher than those in the extraction group in both pre- and post-treatment, but the differences were not statistically significant. In conclusion, the extraction and non-extraction techniques used in orthodontic treatment did not change the inter-caning and inter-molar arch widths. Update Dent. Coll. j: 2022; 12(2): 24-26

Abstract Previous studies have largely failed to clarify the relationship between p16INK4A status and cervical adenocarcinoma prognosis. The current study aimed to examine the clinical and pathological significance of p16INK4A expression in several cervical adenocarcinoma subtypes. Eighty-two samples collected from patients with cervical adenocarcinoma were formalin fixed and paraffin embedded. Next, p16INK4A levels were analyzed with immunohistochemistry. Additionally, the relationship between p16INK4A expression and clinicopathological factors as well as prognosis was evaluated. The expression of p16INK4A was mostly detected in all usual cervical adenocarcinoma subtypes. In the gastric type, only a few cases were positive for p16INK4A expression. Results of the Kaplan–Meier analysis indicated that the positive p16INK4A expression in tumor cells was significantly associated with favorable progression-free survival and overall survival in patients with cervical adenocarcinoma (p = 0.018 and p = 0.047, respectively, log-rank test). Our findings suggest that the status of p16INK4A expression may influence prognosis. Thus, p16INK4A expression could be used as a biomarker for improving the prognosis of patients with cervical adenocarcinoma.

Type II endometrial cancer (EC) is responsible for most endometrial cancer-related deaths due to its aggressive nature, late-stage detection, and high tolerance to standard therapies. Thus, novel treatment strategies for type II EC are imperative. For patients with mismatch repair-deficient (dMMR) tumors, immunotherapy with immune checkpoint inhibitors represents a promising therapeutic strategy. However, the prevalence of dMMR tumors in type II EC patients remains unclear. In this study, using immunohistochemistry, we evaluated the expression of mismatch repair (MMR) proteins, tumor-infiltrating lymphocytes (CD8+), and immune checkpoint molecules (PD-L1) in 60 patients with type II EC (16, 5, 17, and 22 were endometrioid G3, serous, de-differentiated, and carcinosarcoma cases, respectively) to investigate the therapeutic effect of immune checkpoint inhibitors. Approximately 24 cases (40%) had a loss of MMR protein expression. The positivity rate of CD8+ (p = 0.0072) and PD-L1 (p = 0.0061) expression was significantly associated with the dMMR group. These results suggest immune checkpoint inhibitors (anti-PD-L1/PD-1 antibodies) could effectively treat type II EC with dMMR. The presence of dMMR might be a biomarker for a positive response to PD-1/PD-L1 immunotherapy in type II EC.

Abstract Background Neutropenic enterocolitis (NE) is a potentially life-threatening disease that primarily occurs in cancer patients treated with chemotherapy. NE has substantial morbidity and mortality, and its incidence has increased with the widespread use of chemotherapeutic agents such as taxanes, gemcitabine, and leucovorin in patients with lung, breast, gastric, and ovarian cancers. Sometimes NE can be a possible cause of death. Although, conservative approaches are often successful, there are currently no standardized treatment guidelines for NE and it is unclear when such strategies should be implemented. Therefore, we present this report to provide a greater insight into the possible treatment of NE. Case presentation We report the case of a 72-year-old woman with endometrial cancer who was undergoing treatment for hypertension, obesity and diabetes mellitus. The patient initially developed paralytic ileus on the 6th postoperative day (POD) after surgery for endometrial serous carcinoma. Complete recovery was achieved after 4 days of fasting and fluid replacement therapy. On the 27th POD, she received the first cycle of combination chemotherapy consisting of paclitaxel and carboplatin. On day 5 of chemotherapy, she developed the systemic inflammatory response syndrome including febrile neutropenia and sepsis. She then developed disseminated intravascular coagulation (DIC) and septic shock. The patient was subsequently moved to the intensive care unit (ICU). Despite initiating the standard treatment for septic shock and DIC, her overall status worsened. It was assumed that gut distention had led to bowel damage, subsequently leading to bacterial translocation. Thus, she developed NE with severe DIC and septic shock. We decided to reduce the intestinal pressure using an ileus tube to suction the additional air and fluid, even though doing so had a risk of worsening her general condition. The inflammatory reaction subsided, and her general condition improved. The patient recovered after 18 days in the ICU and was discharged alive. Conclusions Herein, we describe a patient with suspected chemotherapy-associated NE. Our observations suggest that postoperative ileus may be one of the possible causes of NE. Patients who experience postoperative ileus must be carefully monitored while undergoing chemotherapy.

Total laparoscopic hysterectomy (TLH) is one of the techniques feasible for the treatment of myoma. Our department has performed more than 1,000 laparoscopic hysterectomies since 2014. In our department, these surgeries are performed by a supervising doctor, operator, and a first assistant who is often insufficiently experienced. There are several types of injuries that can occur during laparoscopic surgery; however, cases in which the vaginal pipe is inserted incorrectly are very rare. Here, we report the case of a 47-year-old nulliparous woman who experienced a rectal injury caused by the misinsertion of a vaginal pipe into the rectum. Seven years prior, she had undergone a myomectomy for leiomyomas. Later, she developed recurrent leiomyomas and worsening hypermenorrhea; therefore, she underwent a total laparoscopic hysterectomy. During the operation, the first assistant usually inserts a vaginal pipe into the vagina when the vaginal wall is cut. In this case, when the vaginal wall was cut, the vaginal pipe was inserted into the rectum, and the rectal wall was incised, allowing communication between the rectum and vagina. The rectum was repaired with the support of a gastroenterological surgeon, and the operation was completed laparoscopically. On the 7th postoperative day, an enema was performed to confirm that no leaks were present, and feeding was restarted. The patient was discharged home on the 17th postoperative day. The current case highlights the necessity of surgeons to be aware of various factors when performing this procedure to prevent complications, even those that are rare.

Background: Globally, over a million people commit suicide every year. Although suicide rates are more in high-income countries, many countries do not report suicide cases regularly to the World Health Organization (WHO). Therefore, this study aimed to determine the factor associated with suicide and self-harm in Pakistan. Method: This cross-sectional study was conducted at Peoples Medical College Hospital (PMCH) in Shaheed Benazirabad, Sindh, Pakistan, from July to December 2019. A total of 131 cases of suicide/self-harm were included using a convenience sampling technique. Data were collected on a predesigned questionnaire consisting of 14 close-ended questions. A chi-square test was used to determine the association between different categorical variables. Results: The majority of the subjects were males (53.4%), young adults aged between 16 and 30 years (69.5%), single (51.9%), and uneducated (57.3%). More than half (51.9%) of the subjects who attempted suicide or self-harm were unemployed. There was a significant association between education level (Χ² =13.149, P = 0.001) and age groups (Χ² = 15.554, P = 0.001) with health outcomes (suicide or self-harm) only. Moreover, gender (Χ² = 20.776, P = 0.004), marital status (Χ² = 69.047, P < 0.001), level of education (Χ² = 63.144, P < 0.001), age groups (Χ² = 69.848, P < 0.001), and employment status (Χ² = 28.677, P = 0.012) were also associated with the reasons of suicide and self-harm. Conclusion: Our study concluded that mostly single, unemployed males with low literacy and with marital and family issues are determined as factors associated with a high risk of self-harm and suicide. [ABSTRACT FROM AUTHOR]

Skills are essential for people with exceptional needs. They are able to uncover their natural talent. Pre-vocational services may be provided to people with IDDs in an effort to prepare them for the workforce before they enter the broad field of vocational skill training (Kirono, 2013). The objective of the existing research was to explore the needs of the Pre-vocational skills of the Persons with Mild Intellectual and Developmental Disabilities (MIDDs. Philosophical research paradigm of current study was quantitative. Data were composed through a structured survey questionnaire with five points multiple directional scale for parents of the persons with MIDDs. Sample of the study was consisted of 151 parents of MIDDs studying in Government Special Education and training institutes of Punjab. Major findings of the research showed that functional academic skills were assessed to be the most problematic pre-vocational skills of MIDDs. The study recommended that persons with MIDDs should be taught according to the individualized educational program. [ABSTRACT FROM AUTHOR]

Abstract Background Laparoscopic myomectomy (LM) is one of the techniques feasible for the treatment of intramural myoma. This technique is reported to be difficult when large fibroids are involved because of excessive blood loss during surgery. Skillful and fast suturing appears to be associated with reduced blood loss during LM. In this study we compared the surgical outcomes of using bidirectional Stratafix® barbed suture versus conventional suture during LM. Methods This retrospective study included all patients who underwent LM for the treatment of intramural myoma in our institution between 2015 and 2020. The patients were divided into 2 groups according to the technique of suturing during LM: Group 1 comprised patients in whom Stratafix® barbed suture was used (n = 29), and group 2 comprised those in whom conventional suture was used (n = 15). Data of patient age, myoma size, the number of myoma nodes, hemoglobin levels, total operation time, total suturing time, and blood loss during surgery were compared between the 2 groups. Results No significant differences in age (p = 0.463) or myoma size (P = 0.373) were observed between the 2 groups. Operation time (P = 0.0104), suturing time (P = 0.007), and blood loss (P = 0.0375) during surgery were significantly less with Stratafix® barbed suture than with conventional suture. No patient required intraoperative transfusion or conversion to laparotomy. Conclusion The use of bidirectional barbed suture reduces operation time, suturing time, and blood loss. As these new sutures have barbs, no knot-tying is required; thus, continuous suturing becomes very simple and maintaining hemostasis is easy. Unskilled gynecological surgeons who apply this suture technique can also perform LM easily. As the bidirectional barbed suture has multiple points of fixation, this suture technique can reapproximate tissue securely, which reduces the chances of reoperation because of proper suture knotting. Therefore, bidirectional Stratafix® barbed sutures could be an optimal and efficient alternative to conventional sutures for use by gynecological surgeons in Japan.

Background: Given that total laparoscopic hysterectomy (TLH) is less invasive than open surgery, its popularity has increased in Japan. The aim of the present study was to determine the most appropriate uterine size for the safe completion of TLH for the treatment of uterine leiomyomas. Methods: This retrospective study included 505 patients who underwent TLH for uterine leiomyomas. Patients were divided into three groups according to the weight of the excised uterus (1000 g, n = 33). TLH procedures were performed by a resident physician under the supervision of an attending physician. Clinical outcomes including blood loss and duration of surgery were collected from patients’ electronic medical records and compared according to uterine size. Magnetic resonance imaging (MRI) was performed prior to TLH for detection, localization, and measurement of the myoma. Results: Mean operation times were shortest (1000 g: 209 min) and the mean volume of blood lost was lowest (1000 g: 402 mL) in patients with a uterus weighing less than 500 g. There were no significant differences in operation time or bleeding between those with a uterine weight of 500–1000 g or >1000 g. MRI revealed that myomas tended to be restricted within the sacral promontory in patients with uterine weights