Search

Background COVID-19 patients have encountered either central or peripheral nervous system affliction. However, there was no connection discovered between the COVID-19 very severe variant and neurological system disease, particularly neuropathy. Abnormalities in the biochemical markers of sepsis, neuroinflammation, and cytokine storm may be used to explain nervous system affection in COVID-19. Aim of the work This research aims to evaluate the relationship between the biochemical and radiological severity of COVID-19 and the peripheral neuropathy experienced by some COVID-19 patients. Patient and methods A comparative cross-sectional study was carried out on a sample of 175 adult patients who had positive COVID-19 PCR results. Patients were selected from records of those who have previously visited Ain Shams University hospitals with documented COVID-19 affection in the past two years (2020 and 2021). All patients underwent to baseline evaluations that include a complete medical history, a neurological examination, laboratory investigation, and a chest CT scan while being treated for acute COVID-19. Then nerve conduction study done for all patient have the inclusion criteria. Result Eighty-seven patients (50%) were female and 87 patients (50%) were male,with age range from 17 to 75 years (42.95 ± 12.12). The patient were divided to 4 groups according to COVID-19 affection, asymptomatic group 29 patient with 14 (48.3%) female and 15 (51.7%) male with age range from 20 to 63 year (43.1 ± 12.05), 49 patient mild COVID-19 with 30 (61.2%) female and 19 (38.8%) male with age 21–64 year (42.53 ± 11.31), 59 moderate COVID-19 with 26 female (44.1%) and 33 (55.9%) male with age range 23–75 year (44.51 ± 12.51), 37 severe COVID-19 with 17 female (45.9%), and 20 male (54.1%) with age 17–69 year (40.59 ± 12.71). There was no significant statistical difference between all groups regarding age (P value 0.492) and sex (P value 0.311) Regarding axonal peripheral neuropathy, there was 29 patient (100%) for asymptomatic group, 49 (100%) for the mild group, 55 (93.2%) for moderate group and 34 (91.9%) for the severe group having negative study and 0 (0%) for asymptomatic group, 0 (0%) for mild group, 4 (6.8%) for moderate group and 3 (8.1%) for severe groups having positive affection for axonal peripheral neuropathy with nonsignificant statistical difference between all groups(P value 0.110). For peripheral neuropathy there was 28 (96.6%) for asymptomatic group,44(89.8%) mild group, 50 (84.7%) moderate group and 26 (70.3%) severe group having negative study for peripheral neuropathy and 1 (3.4%) for asymptomatic group,5 (10.2%) mild group, 9 (15.3%) moderate group and 11 (29.7%) severe group having positive study for peripheral neuropathy with significant statistical difference between all groups(P value 0.017). Conclusion In our study, the peripheral neuropathy affection following COVID-19 infection was not statistically significant, with peripheral neuropathy being more prevalent than axonal peripheral neuropathy, borderline demyelinating LL, UL sensory motor being more frequent, and peripheral nerve affection being more prevalent in cases with a history of moderate and severe COVID-19 affection.

Abstract Background Periodontal accelerated osteogenic orthodontics (PAOO) is a widely-used clinical procedure that combines selective alveolar corticotomy, particulate bone grafting, and the application of orthodontic forces. Different modifications of PAOO such as collagen-membrane coverage can better benefit patients from preventing displacement of grafts. Due to its stability, collagen-membrane coverage gradually gained popularity and became a widely-used procedure in traditional PAOO technique. Objectives To quantitatively investigate the radiographic changes of alveolar bone, periodontal soft tissue changes of the mandibular anterior teeth and postoperative complications in periosteum-covered techniques compared with traditional surgical technique in PAOO. Methods Orthodontic camouflage for dental Class II or decompensation for skeletal Class III malocclusions were included; Patients with bone defects on the buccal aspects of the anterior mandible regions confirmed by clinical and radiographic examination were randomly divided into the periosteum coverage group or traditional technique group for PAOO. Cone-beam computerized tomography (CBCT) scans were obtained before treatment (T0) and 1 week (T1) and 12 months (T2) after operation. The primary outcome variable was the vertical alveolar bone level (VBL), the secondary evaluation parameters included labial horizontal bone thickness at the midpoint of the middle third (MHBT) or apical third (AHBT) to the limit of the labial cortical surface during a 12-month follow-up. Postoperative sequelae were evaluated after 2 days and 7 days in both the groups. Periodontal parameters were analyzed at T0 and T2. Results Thirty-six adult subjects were eligible and recruited in the present study. Although experimental group exhibited more severe infection, no significant differences of the postoperative symptoms or periodontal parameters was found between the 2 groups (P > 0.05). All patients were examined respectively using CBCT at baseline (T0), postoperative 1 week (T1) and 12 months (T2). Both alveolar bone height and width increased from T0 to T1 (P

Objective: To investigate characteristics of temporomandibular joint (TMJ) idiopathic condylar resorption (ICR) and analyze the related factors. Methods: A total of 755 consecutive patients (150 with ICR and 605 with anterior disc displacement [ADD]) from July 2015 to December 2018 were recruited. A comprehensive questionnaire characterizing the multidimensional impact of the TMJ was designed. Clinical examination and radiological evaluation were also performed. The odds ratio for each variable in the ICR group versus the ADD group was computed using logistic regression analysis. Results: Multivariate logistic regression analysis showed significant correlations between mouth opening restriction, disease course, mandibular retrusion, mandibular retrusion progression, skeletal Class II profile, and overjet in ICR patients. Conclusion: These results suggest that a longer ADD disease course might have a strong relationship with ICR. [ABSTRACT FROM AUTHOR]

Abstract Autophagy is a highly conserved catabolic process seen in eukaryotes and is essentially a lysosome-dependent protein degradation pathway. The dysregulation of autophagy is often associated with the pathogenesis of numerous types of cancers, and can not only promote the survival of cancer but also trigger the tumor cell death. During cancer development, the microbial community might predispose cells to tumorigenesis by promoting mucosal inflammation, causing systemic disorders, and may also regulate the immune response to cancer. The complex relationship between autophagy and microorganisms can protect the body by activating the immune system. In addition, autophagy and microorganisms can crosstalk with each other in multifaceted ways to influence various physiological and pathological responses involved in cancer progression. Various molecular mechanisms, correlating the microbiota disorders and autophagy activation, control the outcomes of protumor or antitumor responses, which depend on the cancer type, tumor microenvironment and disease stage. In this review, we mainly emphasize the leading role of autophagy during the interaction between pathogenic microorganisms and human cancers and investigate the various molecular mechanisms by which autophagy modulates such complicated biological processes. Moreover, we also highlight the possibility of curing cancers with multiple molecular agents targeting the microbiota/autophagy axis. Finally, we summarize the emerging clinical trials investigating the therapeutic potential of targeting either autophagy or microbiota as anticancer strategies, although the crosstalk between them has not been explored thoroughly.

Abstract The objective of this study is to introduce the application of augmented reality (AR) navigation system developed by the authors in recontouring surgery of craniofacial fibrous dysplasia. Five consecutive patients with craniofacial fibrous dysplasia were enrolled. Through three-dimensional (3D) simulation, a virtual plan was designed to reconstruct the normal anatomical contour of the deformed region. Surgical recontouring was achieved with the assistance of the AR navigation system. The accuracy of the surgical procedure was assessed by superimposing the post-operative 3D craniomaxillofacial model onto the virtual plan. The pre-operative preparation time and operation time were also counted. In all patients, AR navigation was performed successfully, with a mean ± SD of the errors of 1.442 ± 0.234 mm. The operative time of the patients ranged from 60 to 80 min. The pre-operative preparation time was 20 min for each patient. All the patients showed uneventful healing without any complications, in addition to satisfaction with the post-operative aesthetics. Using our AR navigation system in recontouring surgery can provide surgeons with a comprehensive and intuitive view of the recontouring border, as well as the depth, in real time. This method could improve the efficiency and safety of craniofacial fibrous dysplasia recontouring procedures.

ObjectiveTo realize the three-dimensional visual output of surgical navigation information by studying the cross-linking of mixed reality display devices and high-precision optical navigators.MethodsApplying quaternion-based point alignment algorithms to realize the positioning configuration of mixed reality display devices, high-precision optical navigators, real-time patient tracking and calibration technology; based on open source SDK and development tools, developing mixed reality surgery based on visual positioning and tracking system. In this study, four patients were selected for mixed reality-assisted tumor resection and reconstruction and re-examined 1 month after the operation. We reconstructed postoperative CT and use 3DMeshMetric to form the error distribution map, and completed the error analysis and quality control.ResultsRealized the cross-linking of mixed reality display equipment and high-precision optical navigator, developed a digital maxillofacial surgery system based on mixed reality technology and successfully implemented mixed reality-assisted tumor resection and reconstruction in 4 cases.ConclusionsThe maxillofacial digital surgery system based on mixed reality technology can superimpose and display three-dimensional navigation information in the surgeon's field of vision. Moreover, it solves the problem of visual conversion and space conversion of the existing navigation system. It improves the work efficiency of digitally assisted surgery, effectively reduces the surgeon's dependence on spatial experience and imagination, and protects important anatomical structures during surgery. It is a significant clinical application value and potential.

Radiotherapy at the temporomandibular joint (TMJ) area often results in trismus, however, post radiation ankylosis is extremely rare and has not been previously reported in literature. Radiation is known to impact the vasculature of bony structures leading to bone necrosis with certain risk factors including surgical intervention, even teeth extraction, that could lead to osteoradionecrosis. Accordingly, gap arthroplasty for such case seemed rather challenging. In this report, we introduce for the first time, a rare case of temporomandibular joint ankylosis post radiotherapy for management of rhabdomyosarcoma in a 12 years-old boy. A modified gap arthroplasty technique combined simultaneously with pterygo-masseteric muscle flap was applied to lower the risk of osteoradionecrosis due surgical trauma at irradiated area. Computed tomographic scan on the head indicated that the TMJ architecture was completely replaced by bone, with fusion of the condyle, sigmoid notch, and coronoid process to the zygomatic arch and glenoid fossa. The patient’s problem was totally solved with no osteoradionecrosis or relapse of ankylosis observed at follow up visits. Herein, the modified gap arthroplasty combined with pterygo-masseteric muscle flap could be recommended to be applied on other cases of ankylosis especially after receiving radiotherapy.

Abstract Background Periodontally accelerated osteogenic orthodontics (PAOO) is a treatment for bone defects associated with a lack of bone graft stability, especially in coronal locations. This study aimed to compare a modified technique of membrane fixation that utilizes periosteal sutures (using a pouch design) with the traditional approach, which does not use membrane fixation. Methods Twenty-eight patients with a total of 168 teeth treated were divided into two groups: 1-A, in which patients were treated using the modified technique (with membrane fixation), and group 2-B, in which patients were treated using the traditional technique (without membrane fixation). The postoperative bone thickness was evaluated via radiographic examination. Results Postoperative improvements in bone augmentation were detected in both groups. At 12 months, the values of the CHBT (measured from the midpoint of the coronal third to the labial cortical surface, 0.84 ± 0.33 mm) and the values of VBL (measured from the alveolar crest to the cemento-enamel junction, − 2.35 ± 0.80 mm)were significantly greater in the modified technique group than those in the traditional technique group (CHBT:0.12 ± 0.21 mm and VBL:-1.39 ± 0.99 mm; P = 0.00 and P = 0.01). Conclusions This study shows that compared to the traditional technique, the modified PAOO technique with membrane fixation using periosteal sutures provides improved graft stabilization, superior coronal augmentation and satisfactory vertical volume.

Abstract Background Tongue squamous cell carcinoma (TSCC) is a special type of oral cancer. Cervical lymph node relapse may occur in a large percentage of TSCC patients, which usually indicates poor prognosis. In this cohort study, we focused on the predictive value of the pathological features on cervical lymph node relapse and TSCC prognosis (disease free survival). Methods One hundred forty-one TSCC patients staged as T1–2N0 were enrolled and categorized. Subjects were followed-up for 60 months. Univariate analysis was performed with Chi-square test for cervical lymph node relapse and Kaplan-Meier survival analysis and log rank P value for patient prognosis; multivariate analysis was also utilized with Cox regression. Results In univariate analysis, trabes growth pattern, depth of invasion greater than 4 mm, poor pathological differentiation and neurovascular invasion were considered as risk factors for cervical lymph node relapse and poor prognosis. In multivariate analysis, only patients with trabes growth pattern in the invasive front or depth of invasion larger than 4 mm had a higher risk of metastasis. Elder age group and trabes growth pattern of invasive front were considered as predictors of poor prognosis. Bad habits of smoking and alcohol consumption were related to the higher risk of metastasis. Conclusion Trabes growth pattern of invasive front was a potent risk factor for TSCC cervical lymph node relapse and indicated poor prognosis. Preventive therapy including selective neck dissection was thus suggested for certain patients. Trial registration Not applicable.

Background & Aim: Anxiety related to the COVID-19 is prevalent amongst the nursing workforce potentially affecting nurses’ well-being and their organizational commitment. The nurse manager’s caring behavior has been recognized as a crucial indicator of nurses' resilience with the COVID-19 pandemic. This study aimed to investigate the effect of COVID-19 anxiety on frontline nurses’ organizational commitment and their perception of nurse managers' caring behavior. Methods & Materials: This study utilized an explanatory research design; hence, a convenient sample consisted of 60 registered nurses working at three selected medical intensive care units located in one of the Cairo University Teaching hospitals, Egypt was selected. Data were collected using the Coronavirus Anxiety Scale, Nursing Staff Organizational Commitment Questionnaire, and Nurse Managers' Caring Behavior Questionnaire. Statistical Package for the Social Sciences (SPSS) version 20 was used for the data analysis where the descriptive statistics, Simple Linear, and Stepwise multiple regression analysis were applied. Results: The highest-rated anxiety problem of COVID-19 was appetite loss (x ̅=3.03, SD = ±0.88). Human respect as one of the perceived nurse managers caring behaviors emerged as a strong predictor (Partial R2 = 0.104, p= .017) in increasing the frontline nurses’ organizational commitment, while COVID-19 anxiety has a significant decreasing effect (Partial R2 = 0.435, p

ObjectiveAn evidence regarding which bony flap for reconstruction of mandibular defects following tumour resection is associated with the highest survival rate is still lacking. This network meta-analysis (NMA) aimed to guide surgeons selecting which vascularized osseous flap is associated with the highest survival rate for mandibular reconstruction.MethodsFrom inception to March 2021, PubMed, Embase, Scopus, and Cochrane library were searched to identify the eligible studies. The outcome variable was the flap survival rate. The Bayesian NMA accompanied by a random effect model and 95% credible intervals (CrI) was calculated.ResultsTwenty-two studies with a total of 1513 patients, comparing four osseous flaps namely fibula free flap (FFF), deep circumferential iliac artery flap (DCIA), scapula flap, and osteocutaneous radial forearm flap (ORFF) were included. The respective survival rates of FFF, DCIA, Scapula, and ORFF were 94.50%, 93.12%, 97%, and 95.95%. The NMA failed to show a statistically significant difference between all comparators (FFF versus DCIA (Odd ratio, 1.8; CrI, 0.58,5.0); FFF versus ORFF (Odd ratio, 0.57; CrI, 0.077; 2.9); FFF versus scapula flap (Odd ratio, 0.25; CrI, 0.026; 1.5); DCIA versus ORFF (Odd ratio, 0.32; CrI, 0.037; 2.1); DCIA versus scapula flap (Odd ratio, 0.14; CrI, 0.015; 1.1) and ORFF versus scapula flap (Odd ratio, 2.3; CrI, 0.16; 34)).ConclusionWithin the limitations of the current NMA, FFF, DCIA, Scapula, and ORFF showed a comparable survival rate for mandibular reconstruction. Although the scapula flap reported the highest survival rate compared to other osseous flaps for mandibular reconstruction; however, the decision making when choosing an osseous flap should be based on many factors rather than simply flap survival rate.

Background: Temporomandibular joint arthroscopy (TMJA) is often performed under general anaesthesia (GA) worldwide on an inpatient basis, whereas local anaesthesia (LA) is not equally considered as the standard procedure. Objectives: To compare the efficacy between LA and GA when performing TMJA. Methods: This study retrospectively reviewed a total of 182 patients in LA group and 91 patients in GA group who underwent TMJA for the management of disc displacement. Patients were divided into two groups based on type of anaesthesia used for surgery; LA group and GA group. Comparisons were made based on operative time, intubation and extubation time (for GA only), hospital stay duration, total cost and post‐operative clinical and radiological outcomes. Results: The demographics and pre‐operative clinical assessments were matched in both groups. No post‐operative significant difference was found in outcomes when performing TMJA under LA compared to GA in terms of pain reduction (p =.016) and improvement in mouth opening (p =.866). The median operative time and hospital stay duration for LA group were significantly less compared to GA group (p <.001). GA group required an additional intubation and extubation time, whereas LA group patients were waived from it. TMJA for LA group was performed in the minor procedure setup, which reduced the costs for surgery (p <.001). Post‐operative disc position was excellent and good with an overall success rate of 95%. Conclusion: The use of LA performing TMJA reduces operating time, costs, hospital stay and recovery room time than GA group. Furthermore, TMJA performed under LA shared similar post‐operative clinical and radiological outcomes with those performed under GA. [ABSTRACT FROM AUTHOR]