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Background: The first permanent molar (FPM) is the most caries prone tooth in the permanent dentition. Sometimes early extraction of badly decayed first permanent molars must be considered because of their poor long-term prognosis. This is a complex problem, and there is no consensus in the literature for the treatment management of these children. That is why the pediatric dentist and the orthodontist must work as a team and consider many factors before determining the appropriate treatment method. Case Report: The aim of this clinical report is to present a complex interdisciplinary treatment approach for an 11-year-old girl with history of early childhood caries and multiple restorations on her permanent upper front teeth and 4 non-restorable first permanent molars. Conclusion: The compromised teeth were extracted and new stable positions of the second permanent molars were achieved. The future eruption of the third molars will allow this patient to have fully functional dentition with 28 teeth. Clinical significance: This case illustrates that extraction of all 4 FPM and a careful planed orthodontic treatment can be beneficial to the oral health of young patients if it is done well. Extraction of first permanent molars at a young age is a difficult decision. Therefore, it is recommended that a team of pediatric dentist and an orthodontist plan the treatment together as soon as possible after detection of a compromised FPM. Keywords: Extraction, First permanent molars, Interdisciplinary treatment, Orthodontic treatment.

The COVID‐19 pandemic has affected the health and healthcare of individuals of all ages worldwide. There have been multiple reports and reviews documenting a milder effect and decreased morbidity and mortality in the pediatric population, but there have only been a small number of reports discussing the SARS‐CoV‐2 infection in the setting of an inborn error of metabolism (IEM). Here, we report two patients with underlying metabolic disorders, propionic acidemia and glutaric aciduria type 1, and discuss their clinical presentation, as well as their infectious and metabolic management. Our report demonstrates that individuals with an underlying IEM are at risk of metabolic decompensation in the setting of a COVID‐19 infection. The SARS‐CoV‐2 virus does not appear to cause a more severe metabolic deterioration than is typical.

Fifty-one patients suffering an acute episode of schizophrenia and treated with aripiprazole long-acting injectable (ALAI) were chosen to elaborate an observational study in two in-patient units in Spain, in order to examine the effects of early administration during a hospital admission. When treatment with ALAI is administered in the first week of admission (in 31 patients, 60.78%), hospitalization time is significantly reduced, 12.1 days on average. It can be concluded that ALAI is an effective treatment for these patients. Analysis in economic terms and comparison with other LAI antipsychotics are interesting lines for further research.

Robot-assisted nipple-sparing mastectomy with immediate reconstruction is currently performed in an attempt to seek smaller and indistinct incisions. Robotic surgery system has been evolving under the concept of minimal invasive technique which is a recent trend in surgery. One of the latest version is the da Vinci SP Surgical System (Intuitive Surgical). In this report, we will share our experiences. Two patients underwent robot-assisted nipple-sparing mastectomy, each followed by immediate robot-assisted expander insertion and prepectoral direct-to-implant breast reconstruction, respectively. There was no open conversion or major postoperative complication. One patient experienced mild infection, which was resolved by intravenous antibiotic treatment. Simple docking process, multi-joint instruments, and third-arm functionality are among the new surgical system’s advantages. The present cases suggest that robot-assisted nipple-sparing mastectomy with immediate reconstruction using the da Vinci SP Surgical System is feasible and safe. The promising features and potential application of da Vinci SP in breast reconstruction need further study.

This clinical report describes the management of an esthetic challenge in an interdisciplinary manner addressing both the soft tissue and the anterior dentition. Different restorative materials were used in an esthetic and conservative manner to provide a pleasing smile. A minimally invasive approach was adopted to manage the anterior esthetics problems, including a maxillary diastema and inadequate width-to-length tooth proportions.

Cerebellofaciodental syndrome is characterized by facial dysmorphisms, intellectual disability, cerebellar hypoplasia, and dental anomalies. It is an autosomal-recessive condition described in 2015 caused by pathogenic variants in BRF1. Here, we report a Brazilian patient who faced a diagnostic challenge beginning at 11 months of age. Fortunately, whole-exome sequencing (WES) was performed, detecting the BRF1 variants NM_001519.3:c.1649delG:p.(Gly550Alafs*36) and c.421C>T:p.(Arg141Cys) in compound heterozygosity, thus finally achieving a diagnosis of cerebellofaciodental syndrome. The patient is currently 25 years old and is the oldest patient yet reported. The clinical report and a review of published cases are presented. Atlanto-occipital fusion, a reduced foramen magnum and basilar invagination leading to compression of the medulla-spinal cord transition are skeletal findings not reported in previous cases. The description of syndromes with dental findings shows that such anomalies can be an important clue to relevant differential diagnoses. The cooperation of groups from different international centers made possible the resolution of this and other cases and is one of the strategies to bring medical advances to developing countries, where many patients with rare diseases are difficult to diagnose definitively.

Mutations in the epidermal growth factor receptor (EGFR) are the most common targetable alterations in lung adenocarcinoma. To facilitate rapid testing, the Idylla EGFR assay was incorporated as a screening method before next-generation sequencing (NGS). Validation and experience using an in-house developed analysis pipeline, enhanced with a manual review algorithm is described. Results are compared with corresponding NGS results. In all, 1249 samples were studied. Validation demonstrated 98.57% (69/70) concordance with the reference methods. The limit of detection varied from 2% to 5% variant allele frequency for total EGFR quantitation cycle between 20 and 23. Of the 1179 clinical cases, 23.41% were EGFR-positive by Idylla. Concurrent NGS was successfully performed on 94.9% (799/842) requests. Concordance of Idylla with NGS was 98.62% (788/799) and 98.50% (787/799) using our in-house and Idylla analysis pipelines, respectively. Discordances involved missed mutations by both assays associated with low tumor/low input. Incorporating a manual review algorithm to supplement automated calls improved accuracy from 98.62% to 99.37% and sensitivity from 94.68% to 97.58%. Overall reporting time, from receipt of material to official clinical report, ranged from 1 to 3 days. Therefore, Idylla EGFR testing enables rapid and sensitive screening without compromising subsequent comprehensive NGS, when required. Automated calling, enhanced with a manual review algorithm, reduces false-negative calls associated with low tumor/low input samples.

Flow cytometry is a highly sensitive and specific approach for discriminating between normal and clonal plasma cells in multiple myeloma. Uniform response criteria after treatment have been established by the International Myeloma Working Group and the EuroFlow Group; however, the way in which flow cytometry data are reported has suffered from no collaborative or multicentre efforts. This study, involving 8 expert laboratories and 12 clinical hematology units of the Lazio region in Italy, aims to produce a uniform and shared report among the various Centres. From the pre-analytical phase to sample processing, data acquisition, analysis, and evaluation of the potential limitations and pitfalls of the entire process, the study reaches a final conclusion shared by laboratories and clinicians according to the most updated principles and recommendations. The aim was to identify the necessary data to be included in the clinical report by using multiple-choice questionnaires at every single stage of the process. An agreement of more than 75% of the laboratories was considered mandatory for the data to be included in the report. By ensuring the operational autonomy of each laboratory, this study provides a clear report that limits subjective interpretations and highlights possible bias in the process, better supporting clinical decision-making.

An 80-year-old man sought treatment at our hospital. He was dissatisfied with his old complete denture due to its poor stability and retention. The old complete denture had been used for about 20 years. The prolonged use of an unsuitable complete denture led the patient to be accustomed to unilateral mastication (UM). Due to the patient long-term habitual mandibular deviation, using the physiological technique to get the centric relation (CR) achieved an incorrect horizontal maxillomandibular record. This clinical report presents a technique using the existing complete denture mounted with a Gothic arch tracer to determine the CR. This technique is an inexpensive, simple, and reliable method that allows fabricating the final impression and obtaining the maxillomandibular relationship record (MMRR) in one step.

Introduction: Babesiosis is a disease caused by protozoan parasites of the genus Babesia. It is transmitted by ticks and affects a wide range of domestic and wild animals and even humans. Case Presentation: In this study, during the last three and a half years (2017-2021), 18 cats and 8 dogs with Babesia infection have referred to one of the small animal clinics in Tabriz, Iran. Ten of these 18 cats presented with obvious neurological symptoms, of which 7 had severe ocular symptoms in addition to neurological symptoms. The remaining eight had anemia and ocular symptoms and no neurological symptoms. In addition to ocular symptoms, one of the cases showed jaundice and anemia. All cases were in a critical condition at the time of referral to the clinic; that is, they showed all the expected symptoms and were close to death. Conclusion: The aim of this article is to show Babesia as one of the etiological factors of convulsions and neurological symptoms in dogs and cats.

Congenital Cleft lip and palate is a craniofacial defect which results into difficulty in feeding because of the communication between the oral and nasal cavities. Feeding plate restores the gap between the oral and nasal cavities and helps in feeding and reduces the chances of airway problems, regurgitations. This clinical report describes a design and method of fabricating a feeding plate in an 8-day old neonate with a cleft lip and palate.

One of the most critical emergencies in dogs is esophageal foreign bodies. The most important foreign body reported in the esophagus is bone; however, there are also reports of fish hooks lodged in the esophagus. This case report describes the history, clinical signs, radiographic findings and surgical management of an esophageal foreign body due to a single-barbed fish hook in a 4-month-old Siberian Husky female dog with regurgitation, pain, anorexia and lethargy. In this case, plain radiography was taken to determine the type and location of the foreign body and it was confirmed that a single-barbed fish hook was lodged in the heart base of thorax. Depending on the type of foreign body, penetrable or non-penetrable as well as the location, a variety of methods including endoscopy, fluoroscopy, and surgery are used for its removal. For treatment, for the first time, a covault hook was utilized to remove the foreign body via gastrotomy. Case follow-up during two weeks showed no postoperative complications and the patient was healthy.

Ocular tumors are rarely seen in farm animals. Iridociliary epithelial tumors are the second most common tumor of the eye in dogs and cats, but there is just one report of this tumor in sheep. This case report described the history, clinical signs, histopathological and immunohistochemical findings, and surgical management of an iridociliary adenoma tumor in a 3-year-old Iranian Shaal sheep with signs of anorexia, depression, loss of vision, and a mass covering the left eye. The mass had protruded from the left eye globe but had not penetrated the periocular tissues. Enucleation was performed to excise the tumor. Periodic acid–Schiff (PAS) and Alcian blue staining methods were done for the mass, but the result for both of them was negative. Slides were also immunostained for antibodies against cytokeratin AE1/AE3, vimentin, and S-100 protein. The results were positive for vimentin but negative for cytokeratin and S-100. According to the results of histopathology and immunohistochemistry, the type of tumor was diagnosed as iridociliary adenoma. To our knowledge, it was the second report of the iridociliary tumor in the sheep and the first report of this tumor in the Iranian Shaal breed.

Prior to the antibiotics era, the mortality rate from cavernous sinus thrombosis (CST) was very high reaching 100%. There have been very few reports of CST associated with tooth extraction on the same time Coronavirus disease of 2019 (COVID-19) is known to increase the risk of developing venous thromboembolism; therefore, patients with COVID-19 may present with cerebral venous sinus thrombosis. We present a case with diagnostic dilemma and first to be reported in the literature.

Pudendal neuralgia (PN) is an impairing neuropathic disorder, affecting both men and women, involving a severe burning and sharp pain along the course of the pudendal nerve. Treatment is often insufficient, and options are limited. Pulsed radiofrequency (PRF) is a technique which might be useful in therapy. This case series aims to determine the effectiveness of PRF in patients with PN in the context of evaluation of care. Between 2010 and 2016, all female patients of University Medical Center Utrecht diagnosed with PN who experience insufficient pain relief after common treatment were offered PRF. Patient Global Impression of Improvement (PGI‐I) scores were assessed at 3‐month follow‐up and at long‐term follow‐up (median 4 years). PGI‐I scores were recorded to evaluate our quality of care. Twenty patients with PN consented to undergo PRF. We lost one patient in follow‐up. Seventy‐nine percent of the patients described their condition as “(very) much better” at 3‐month follow‐up. At long‐term follow‐up, 89% of the patients described their condition as “(very) much better.” No serious side effects were observed. In conclusion, PRF is a successful treatment option in patients not responding to standard treatment options, including pudendal nerve blocks. PRF of the pudendal nerve can be used for PN to provide relief in patients’ chronic pelvic pain.

Adrenocortical carcinoma (ACC) is a rare aggressive malignancy that originates in the outer layer of the adrenal gland. Most ACCs are sporadic, but a small percentage of cases are due to hereditary cancer syndromes such as Li‐Fraumeni syndrome (LFS), Lynch syndrome (LS), and familial adenomatous polyposis (FAP). Multiple endocrine neoplasia type 2A (MEN2A) is an inherited disorder that predisposes to medullary thyroid cancer, pheochromocytoma, and parathyroid hyperplasia. We present here a case of ACC with both LS and MEN2A; the family and medical history were consistent with Lynch. This is, to our knowledge, the first report of a patient with ACC associated with germline mutations in RET and MSH2, and no phenotypical characteristics of MEN2A.

SUMMARY: The carotid arteries, classically described as taking a relatively straight course through the neck, deviate medially in a minority of patients. At the extreme, the internal carotid arteries may “kiss” in the midline, coming extremely close to the pharyngeal wall. In this clinical report, we describe 5 patients with primary hyperparathyroidism, all with ectopic retropharyngeal parathyroid adenomas but all with varying carotid artery anatomy. We describe these variations using a previously developed clinical grading system that highlights 1) the relationship between carotid artery location and risk of injury during pharyngeal procedures and 2) the importance of universal, objective criteria to classify carotid anatomy. Radiologists should be familiar with variations in carotid anatomy and communicate them to the operative team.

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To evaluate whether use of hydroxychloroquine was associated with a reduced likelihood of intensive care unit (ICU) admission in patients with coronavirus disease 2019 (COVID-19) in the early weeks of the pandemic. Methods A retrospective, observational, cohort study was conducted to determine selected treatment outcomes in 336 patients hospitalized with COVID-19 at an acute care, community hospital in the Hudson Valley region of New York from March 20 to April 20, 2020. Eligibility included admission to the hospital, a laboratory-confirmed diagnosis of SARS-CoV-2 infection, and no need for intubation or intensive care at admission. The median (interquartile range) ages of patients who received hydroxychloroquine (n = 188 ) and those who did not (n = 148) were 68 (58-82) and 64 (51-73) years, respectively. In a multivariable model that included age, gender, obesity, diabetes, and hydroxychloroquine use, patients who received hydroxychloroquine were significantly more likely than those not treated with the drug to be transferred to an ICU (odds ratio, [OR], 8.1; 95% confidence interval [CI]: 3.8-17) and significantly more likely to be intubated (OR, 7.99; 95% CI, 3.76-16.91); these associations were not influenced by disease severity. In-hospital mortality did not differ significantly with disease severity between those who did and those who did not receive hydroxychloroquine. Conclusion Hydroxychloroquine use was significantly associated with increased risks of ICU admission and intubation in patients with mild, moderate, and severe symptoms of COVID-19. There were no significant between-group differences in mortality with use vs nonuse of hydroxychloroquine.

Transition of care (TOC) in adolescents and young adults (AYAs) with chronic gastrointestinal disorders has received increased attention, especially in those with inflammatory bowel disease. AYAs with hereditary polyposis syndromes are a heterogeneous group of patients with overlapping and complex medical needs. These patients are particularly vulnerable because of the risk of loss of continuity of care and subsequent poor disease outcomes. The Pediatric Committee of the American College of Gastroenterology commissioned a report with recommendations on TOC in AYAs with hereditary polyposis syndromes. This report aims at achieving best practice by both pediatric and adult gastroenterologists despite the paucity of published evidence in this population reflected in the included PRISMA report. Therefore, the group extrapolated findings from the literature related to other chronic gastrointestinal disorders, and a high degree of expert consensus was scored for all recommendations. The report addresses TOC through identifying shared domains followed by specific recommendations in disease management, including models of care, providers and patient and socioeconomic factors relevant to TOC. Areas of strong emphasis include the need for early planning, flexibility in the transition process to maintain continuity during major surgical procedures, patient and family psychological readiness, liaison among team members addressing transition, and changing insurance coverage in this population.

Background introduction Nail injuries are important causes of penetrating craniocerebral injuries. Theirs incidence is very low, but the injuries can be fatal. Since the nail gun was gradually popularized in 1959, the incidence of nail injuries has been increasing. Here we report a case of nail gun injury to superior sagittal sinus and review the literature of the past 60 years to find out what are the possible factors of nail gun injury and what are their respective ratios? Clinical report An 18-year-old male patient was accidentally injured in the head by the worker's nail gun, accompanied by scalp pain, no physical sensation disorder, and consciousness disorder. A computed tomography scan of his skull showed the penetrating site at the right frontal area, near the superior sagittal sinus. Seven days later, the patient underwent a successful surgery without neurological sequelae. Discussion Nail injuries are rare, but can be potentially fatal. We found that nail guns were the main cause of nail injuries, and other causes include occupational injury, violence, lack of supervision of young children (potential for domestic violence, and child abuse), mental illness, and suicide attempts. While paying attention to the anatomical location of trauma, clinicians should also think more about the possibility of injury so as to provide better help to patients in time.

Restoring extensively damaged endodontically treated posterior teeth is always a challenge in dentistry. The use of endocrowns has gained popularity in restoring severely damaged endodontically treated teeth (ETT) in recent years. In this clinical report, a structurally compromised mandibular second molar with symptomatic irreversible pulpitis and normal apical tissue was endodontically treated. Surgical crown lengthening was attempted thereafter to increase the crown height. However, marginal periodontal tissue re-growth occurred after surgical crown lengthening. The tooth was subsequently restored with endocrown which was fabricated using computer-aided design and computer-aided manufacturing-based hybrid-ceramic. In conclusion, endocrown can be a viable restorative modality for ETT with compromised clinical crown height.

Background Enteroviral infections in infants

Restricted mouth opening (microstomia) can be defined as a reduction in the circumference of the oral cavity, although the intraoral structures may be of normal size. It is observed that the size of the oral opening decreases, the difficulty increases in required dental treatment. Prosthetic rehabilitation of microstomia patients due to oral sub-mucous fibrosis (OSMF) presents difficulties at all stages, right from preliminary impressions to insertion of prostheses, as the maximal oral opening is smaller than the size of a removal intra-oral prosthesis. To rehabilitate this type of patient successfully, the methods and designs incorporated in the fabrication of prosthesis have to be modified to achieve favourable mastication, retention and aesthetics. This article describes modified primary impression procedure without using tray and other techniques used to fabricate maxillary and mandibular custom sectional trays, sectional denture bases and removable sectional complete dentures for completely edentulous patient with limited oral opening caused by OSMF. Fabricating the sectional denture allows the patient to insert and remove the denture with ease.

Prosthetic rehabilitation of a missing tooth with tilted abutments is yet an enigmatic and less unconventionally sought-after treatment strategy. Many methods have been previously reviewed over the years. This clinical report aims to integrate the principles of the segmented fixed dental prosthesis into a digital workflow. It elucidates the rehabilitation using a split-pontic design that mitigates the issue of developing a common path of insertion without much compromise to the tooth preparation to derive parallel prepared walls. This prosthetic design rather incorporates a common path of insertion into the pontic in the form of a key-keyway non-rigid connector design.

Objective The following is a clinical report addressing when to save or remove implants with esthetic deficiencies in the smile zone as well as the sequence and timing of interdisciplinary treatment. Clinical considerations Key factors in the decision-making process in treating implants in malposition are whether the implants are (1) in a reasonable restorative position, (2) free of disease, and (3) placed with adequate depth. This clinical report encompassed periodontal corrective surgery, non-surgical soft tissue sculpting through subgingival crown contour, material selection for definitive restorations, and cementation techniques for cement-retained restorations. Clinical significance Knowledge and understanding of interdisciplinary treatment planning, sequencing, and respective techniques that can be implemented when confronting implants in malposition in the smile zone will allow the interdisciplinary team to achieve the desired esthetic restorative result.

Introduction: Anterior tooth fracture is the most commonly presenting clinical condition during routine dental practise. Restoration of such tooth is challenging task due to fracture position and amount of remaining coronal tooth structure. Tooth fracture at or below the gingival level usually have a poor prognosis. Treatment options for such clinical conditions range from tooth extraction to prosthodontic rehabilitation with surgical crown lengthening and/or orthodontic extrusion. This clinical report describes a multidisciplinary approach for management of such cases by the orthodontic forced eruption and clinical crown lengthening followed by the final restoration with indirect resin customized post core and crown.

The report describes a 27‐year‐old female patient with amelogenesis imperfecta (AI) accompanied by nocturnal bruxism, who was treated with a combination of occlusal splint and full‐mouth fixed prosthetic rehabilitation through follow‐ups within 2 years. Soft splint protection, regular follow‐up, and monitoring of carries are guaranteed to maintain a long‐term curative effect.

Congenital cleft lip and palate is the most commonly found craniofacial defect. The most common problem in an infant with cleft lip and palate is the difficulty in feeding due to communication between oral and nasal cavity. Difficulty in feeding leads to inadequate nutrition and affects the health of the infant. Feeding problems should be assessed and intervened as early as possible, as they are important aspect of the multidisciplinary team approach in the management of cleft lip and palate. Feeding obturator restores this gap and assists in feeding as well as helps in reduction of airway problems, regurgitations, and frequent infections. This clinical report describes a technique of fabrication of a feeding appliance in a 4 hours old neonate with veau type III cleft lip and palate. Keywords: Cleft lip; cleft palate; obturator; feeding appliance; feeding obturator; Veau Type III cleft lip and palate

Background/aims This study aimed to analyze the data of 24 cases of multiple perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads, to improve the understanding of its harmfulness to children and explore the best treatment. Materials and methods In total, 24 cases were collected and retrospectively analyzed. These patients were divided into two groups: perforation group and non-perforation group. The medical history, number of magnetic beads, white blood cell (WBC) count, and C-reactive protein (CRP) were analyzed. Results There was no significant difference in age, gender, medical history, number of magnetic beads, and WBC count between the perforation group and non-perforation group, but there was a significant difference in CRP. After the diagnosis, 70% of the cases underwent laparotomy and perforation repair. All cases recovered smoothly after the operation, and no complications occurred during the follow-up. Conclusion This study offers diagnosis and treatment methods for the perforation or obstruction of the digestive tract caused by accidental ingestion of magnetic beads and raises the awareness regarding the harmfulness of the presence of foreign bodies in the digestive tract.

Background. The likelihood of foreign bodies presence in the wound exists in almost any injury to the skin. The consequences of their ingress into the body are extremely varied: from the complete absence of symptoms to systemic toxicity, depending both on the nature of the embedded agent and on the way of its penetration. The data of the anamnesis and clinical examination of foreign bodies are not always convincing, and the results of conventional radiography, even with X-ray-positive foreign bodies, are often nonspecific. The parenteral ingression of metallic mercury is rare. In contrast to its access through the respiratory or digestive tract, this route has not been adequately studied. This clinical report is devoted to the clinical case of deliberate self-administration of metallic mercury into the soft tissues of the upper limb. Clinical case description. A 24-year-old patient sought medical help 2 years after the injury and tried to hide its circumstances during taking his anamnesis. Ultrasound played a decisive role in making the diagnosis (foreign body) and revealing its nature (metallic mercury). This indicates the high information content and specificity of ultrasound which exceeded the X-ray capabilities. Despite no signs of general and local toxicity, the presence of mercury in the body is unacceptable and requires the surgical treatment. Our case showed that mercury in soft tissues was limited to granuloma or was fixed inside fibrous tissue. This made it possible to remove it radically. Conclusion. Our observation suggests that ultrasound, in contrast to X-ray, is able to present a specific picture of the existence of metallic mercury in soft tissues. Therefore, it is advisable to include ultrasound in the examination algorithm if any foreign body (especially mercury) is suspected to detect or clarify its nature. If mercury is detected in soft tissues, the radical surgical treatment can be successfully performed, since the reaction of tissues around the mercury material (in the form of granuloma and the confinement of mercury spheres in a conglomerate of fibrous tissue) makes it possible to avoid the spread of mercury along the wound channel.

Tooth extraction in the esthetic area is usually accompanied by hard- and soft-tissue changes. The socket-shield technique is an effective method for preventing these undesirable changes. However, difficulty in preparing the socket shield and controlling the implant position might increase the complication rate along with the time needed for the surgery, limiting its widespread use. This clinical report demonstrates a digital protocol for accurate and rapid socket-shield preparation and implant placement with surgical guides.

Background Since the outbreak of SARS-CoV-2, authorities have preached the importance of personal hygiene, including hand washing and disinfection. Objective To evaluate changes in the frequency of hand washing and hand care, the onset of hand eczema (HE) and risk factors associated with HE since the outbreak of SARS-CoV-2 in Munich in January 2020. Materials & Methods All dermatologic outpatients at the university hospital between April 6 and April 19 were asked to complete a structured questionnaire. Results Data of 512 patients with a median age of 49 years (243 females, 267 males) were analysed. The frequency of hand washing and hand disinfection increased after the outbreak of SARS-CoV-2 (p < 0.001, respectively). While symptoms associated with HE were reported by 29.9% (149/499) of patients, the actual diagnosis of HE was reported less frequently by 11.2% (53/473) with a median duration of 120 days. Frequent hand disinfection (p = 0.039), atopic dermatitis (p = 0.006) and young age (p = 0.0499) were identified as risk factors for symptoms of HE. Hand care was performed more frequently during the pandemic than before (p < 0.001). A high frequency of hand care during the pandemic was not significantly associated with symptoms of HE (p = 0.172), but was associated with self-recognition of HE symptoms (p = 0.002). Conclusion After the outbreak of SARS-CoV-2, the frequency of hand hygiene measures increased. A considerably high prevalence of HE symptoms was associated with frequent hand disinfection, atopic dermatitis and young age. Awareness of HE should be raised in order for preventive measures to be taken earlier.

All conjoined twins are originally born as a result of fertilizing one zygote (egg) and also called monozygotic twins experiencing an incomplete division of an embryo into two portions of the embryo usually causing the formation of the primary streak stage. The main reason for the creation of this defect is not obvious. Dead twin goat with one head, one trunk, four anterior limbs, and four posterior organs was referred to the Laboratory of the Faculty of Veterinary Medicine, Islamic Azad University, Shoushtar Branch, Shoushtar, Iran. The radiographic and three-dimensional images showed one normal skull and pelvic bone vertebral column. The ribs and sternum of the newborn goat were quite normal and confirmed two pairs of extra limbs. There were no doubles in describing the internal organs. This report seems to be the first report regarding a case of a monocephalus, tetrabrachius, and tetrapod newborn goat.

Cervicogenic headache is a secondary headache syndrome attributable to upper cervical spine pathology. Osteoarthritis of the lateral atlantoaxial joint with resultant C2 dorsal root ganglion irritation is an important and potentially treatable cause of cervicogenic headache. In this case series, we present 11 patients with cervicogenic headache who underwent C2 dorsal root ganglion thermal radiofrequency ablation. Radiologists should be familiar with this efficacious procedure and technical considerations to avoid complications.

The purpose of this clinical report is to present the novel management of a type Tessier 3 cleft which was treated using a palatal expander in reverse fashion to reapproximate the craniofacial skeleton allowing for closure of the palate and soft tissue of the cleft. Reapproximation of the bony component of the cleft was achieved without osteotomies and allowed for easier and earlier realignment of the bony and soft tissue components of the cleft. To our knowledge, this is the first use of reverse palatal expansion in the treatment of type 3 Tessier cleft. Reverse palatal expansion made management of this cleft more straightforward and should be considered as a useful adjunct in the management of wide facial clefts.

Prosthetic rehabilitation of a completely edentulous patient no longer confines to only replacement of missing teeth. Patients are increasingly demanding improvement in esthetics at the end of treatment. Aging leads to a high impact on external facial esthetics resulting in slumped cheek leading to undesirable facial esthetics. Cheek plumper is a commonly used prosthesis to enhance the support of sunken cheeks providing better esthetics. This clinical report describes a novel technique to fabricate detachable cheek plumber to improve support for sunken cheeks retained with a ball bearing and a new commercially available material.

Here, we present a case of off-label successful use of the T2 MR (T2Candida® test) for the diagnosis of invasive candidiasis ( Candida albicans endolphthalmitis). This case demonstrates that T2Candida could be performed in sterile body fluids to improve microbiological diagnosis of invasive candidiasis.

Spondylolisthesis known as kinky back syndrome is a deformity of the free sixth thoracic vertebra including enlargement and rotation resulting in posterior paralysis in broiler chicken. Genotype, feeding regimes and environment are involved in occurrence of this congenital anomaly. Spondylolisthesis may result in or happen simultaneously with two other major axial skeleton pathologies including spondylosis and spondylitis as a result of occurrence of degenerative necrobiotic lesions and inflammation of the vertebrae, respectively. This report deals with a male broiler chicken with posterior paralysis in the second week of rearing. After euthanasia, the specimen was evaluated at macroscopic and microscopic levels. Macroscopic findings showed the unilateral enlargement of body and transverse process of sixth thoracic vertebra and downward rotation of the body. The histopathological studies revealed the focal chondronecrosis and degenerative changes in articular facets and cranial process of the vertebra. In conclusion, a diagnosis of spondylolisthesis followed by spondylosis was made based on macroscopic and histopathological findings that to the authors’ best knowledge, is the first report in a broiler farm in Iran.

Intracerebral hemorrhage is rare in term born neonates. Besides several non-genetic risk factors, pathogenic variants in COL4A1 and COL4A2 have been described to play a role in the pathophysiology of neonatal intracerebral hemorrhage. To the best of our knowledge, no intragenic COL4A2 duplications have been reported in humans to date. We report a neonate with intracerebral hemorrhage and a de novo intragenic COL4A2 duplication. Although it is not clear yet whether this genetic factor fully explains the clinical phenotype, it may have contributed at least as a risk factor for cerebral hemorrhage. Screening for intragenic COL4A1 and COL4A2 duplications as part of collagen IV diagnostics should be considered as part of the fetal and neonatal work-up for unexplained cerebral hemorrhages and to collect more evidence of the pathogenicity of this genetic mechanism.

This research examined whether an individual's endorsement of punishment goals moderates and mediates the effect of a clinical assessment of recidivism risk on the length of prison sentences. We measured participants' endorsement of punishment goals, both before they read a criminal case (i.e. a priori endorsement), and after they had read it (i.e. case-specific endorsement). As expected, the effect of the clinical report's conclusion on participants' sentencing decisions was moderated by a priori endorsement of incapacitation as a punishment goal. Participants who expressed strong (versus weak) a priori endorsement of this punishment goal were influenced by the report's conclusion on the risk of recidivism. In addition, when the clinical report concluded that the offender had a high risk of recidivating, participants expressed greater case-specific motivation to incapacitate him. Finally, the clinical report's conclusion had an indirect effect on the severity of the sentence through case-specific endorsement of the incapacitation punishment goal.

Background and Objective Magnetic muscle stimulation (MMS) is a relatively new energy‐based technology that provides a non‐invasive option for body contouring through stimulation and toning of underlying skeletal muscles. This study was conducted to examine the safety, efficacy, and body satisfaction scores of MMS using a CoolToneTM prototype for the aesthetic improvement of abdominal and buttock contour. Study Design/Materials and Methods This was a prospective, non‐comparative, non‐randomized, 12‐week, multicenter study. Male and female participants aged 22‐65 years received 4 MMS treatment sessions to the abdomen and/or buttocks. Body Satisfaction Questionnaire (BSQ) scores for abdomen and/or buttocks were assessed at baseline, immediately post final treatment, at 4 weeks (primary endpoint), and 12 weeks post final treatment. Subject‐rated Global Aesthetic Improvement Scale (SGAIS) was assessed at 4 weeks post final treatment (secondary endpoint), and 12 weeks post final treatment. Additional efficacy assessment included abdominal circumference obtained by 3D imaging at baseline, immediately post final treatment, and at 4 and 12 weeks post final treatment. A Subject Experience Questionnaire (SEQ) was used to assess treatment satisfaction and perspectives at 4 weeks and 12 weeks post final treatment. Adverse events (AEs) were monitored throughout the study. Results A total of 110 participants were recruited, who were 75% female, 80% Caucasian (mostly non‐Hispanic), average age of 39.5 years (range 22–59) with an average body mass index (BMI) of 23.3 kg/m2 (range 18–29.9). At the 4‐week post final treatment visit, the average BSQ score for participants receiving abdominal treatment (n = 93) was significantly improved with a 5.1 average increase in total score from baseline (possible score range 10–50) and by a 5.5 average increase from baseline for participants receiving buttocks treatment (n = 32) (p “Improved” was 68.1% for participants receiving treatment of the abdomen (n = 94), and 81.8% for those receiving buttocks treatment (n = 33). The mean total decrease from baseline in waist circumference was significant at all time points. At the 12‐week post final treatment visit, SEQ data revealed that a majority of participants were “Satisfied” or “Very Satisfied” with overall treatment results and “Agreed” or “Strongly Agreed” that they were motivated to maintain results either by working out or by additional treatment. A total of 6 AEs related to the device and/or treatment were reported, which resolved spontaneously during the study. Conclusion Treatment of the abdomen and/or buttocks with MMS was well‐tolerated and demonstrated significant improvement in aesthetic appearance through the 12‐week post final treatment study duration. As a stand‐alone treatment, MMS expands the range of options for individualized treatment planning for patients seeking abdominal and/or gluteal muscle toning. © 2020 The Authors. Lasers in Surgery and Medicine published by Wiley Periodicals, Inc.

[Purpose] Patients with idiopathic pulmonary fibrosis (IPF) often develop remarkable exercise-induced hypoxemia and are hospitalized for management. The pre-discharge management of activities of daily living (ADL) should determine the amount of exercise-induced hypoxemia permitted during daily activities and inform concrete instructions based on these results. This clinical report aimed to promote 24-hour ambulatory oximetry monitoring in a patient with IPF to guide the pre-discharge management of ADL. [Participant and Methods] Our patient was a 67-year-old male with IPF. He was hospitalized and scheduled to be discharged after introduction of home oxygen therapy. Prior to discharge, we conducted a 24-hour ambulatory oximetry monitoring in the patient's home. We administered instructions on ADL based on these results. Furthermore, 1 day after discharge, we monitored his oxygen saturation level during ADL in his home. [Results] During the pre-discharge monitoring, the patient experienced hypoxemia during bathing, with a minimum oxygen saturation (SpO2) level of 87% and SpO2 level of

Sinus floor elevation with the lateral window approach has proven to be an effective treatment modality for vertical bone augmentation in the posterior region of the maxilla. The simultaneous implant placement during the procedure can be achieved if enough remaining bone height is available to obtain implant primary stability. However, the proper identification of the maxillary sinus boundaries for the window demarcation along with membrane protection for simultaneous implant placement can be challenging. This clinical report demonstrates a novel technique for sinus floor augmentation using a 3D modified implant-osseous-membrane surgical template to assist in the lateral window demarcation, membrane stabilization and protection, and guided implant placement in a partially edentulous patient who was eligible for one-stage sinus floor elevation. The surgical procedure for the sinus demarcation is simplified, the membrane stabilization and protection are effective, and the guided implant placement provided a predictable surgical positioning of the implants.

Background and objectives Acoustic wave therapy is a novel facial tightening technique that involves nonthermal penetration of the skin and subcutaneous tissue, affecting cells and their metabolism, and resulting in an increased release of unwanted fat and activation of blood and lymphatic flow in tissues. The objective of this study was to investigate the effectiveness of acoustic wave therapy. Study design/materials and methods A total of 333 patients underwent multiple facial tightening treatment sessions using focused and radial acoustic waves. Each patient received 2,000-3,000 pulses of focused acoustic waves at a power of 0.45-0.88 mJ/mm2 with a pulse frequency of 3-5 Hz and 4,000 pulses of radial acoustic waves at 4-bar power at a frequency of 21 Hz. These sessions were performed more than three times, and treatments were repeated at 1-month intervals. Digital photographs superimposed three-dimensional volumetric assessments, and three-dimensional skin surface displacement calculations using vectors were used to evaluate the results 12 months after the last treatment. Patients also evaluated the results using a 5-point Likert scale. Results Improvements in skin texture, clarity, and laxity were observed in digital photographs. Superimposed three-dimensional color images showed marked volumetric reduction and/or formative modification for even contour toward the lower mid-face. Most vectors showed three-dimensional skin surface displacement at the lateral sides of the temples, cheeks, and chin, in an upward direction. These results were obtained and sustained for up to 12 months without edematous reactions. Almost all patients reported improvement, with 79% reporting "good" or "excellent" improvement. Complications were minor and transitory. Persistent side effects were not observed. Conclusion Acoustic wave therapy could be used as a standard facial tightening treatment, with skin rejuvenation effects shown on digital photographs and three-dimensional quantification assessments. This noninvasive acoustic wave approach was found to be a safe, long-lasting, and effective method for facial tightening. Lasers Surg. Med. 00:00-00, 2020. © 2020 Wiley Periodicals LLC.

Missing lateral incisors are the most frequent dental disorder associated with cleft alveolus. When orthodontic closure of the edentulous space is not possible, more aggressive prosthodontic treatments are required. Contemporary resin-bonded fixed dental prostheses (RBFDPs) represent a promising, time-efficient alternative treatment with fewer biological complications. This clinical report proposes a modified approach to the esthetic rehabilitation of a patient with a complete unilateral cleft lip and palate on the left side and an incomplete cleft lip and alveolar cleft on the right side. Digital diagnostics, treatment planning, and clinical procedures involved in the fabrication of facially bonded RBFDPs are presented. This modified technique enables the concurrent replacement of lateral incisors and correction of the malformed central incisors as well as increasing the retention of the restorations.

Subtotal reconstruction of the lower lip after excision of the tumor is always a challenge for surgeons. It is because of the difficulty in regaining the function of the lip, including the oral competency and restoring the aesthetic subunit. A 46-year-old patient presented with an ulceroproliferative growth involving 70% of the lower lip, including the right commissure. After the confirmation to be a malignancy, patient underwent excision of the tumour and reconstruction of the lower lip using the left Karapandzic flap and right nasolabial flap. The patient was on regular follow-up in the postoperative period to assess the surgical outcomes. The combined use of Karapandzic flap and the nasolabial flap can be reliably used for subtotal reconstruction of the lower lip in advanced oral cavity malignancy, involving one of the commissures. Later can ensure good postoperative results in terms of aesthetic and functional lip reconstruction without any significant intraoperative or postoperative complications.