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Distalization is widely used as an effective method of gaining space with or without the need of extractions. Various Extra-oral and intra-oral appliances have been introduced over the years. The pendulum appliance and its modifications are specifically very popular among clinicians owing to their effectiveness. The present case series comprises of two cases that have been effectively treated using the pendulum appliance ensuing in aesthetically pleasing outcomes.

Anticoagulation and antiplatelet therapy are individually mainstays of treatment for multiple cardiovascular conditions. Antiplatelet therapy, most commonly with dual agents, is vital in the setting of coronary artery disease with acute coronary syndrome requiring percutaneous coronary intervention to prevent in-stent complications. A multitude of cardiovascular conditions with increased thromboembolic risk also require anticoagulation, including atrial fibrillation, venous or arterial thrombosis, and prosthetic heart valves to name a few. There is often an overlap in comorbidities as our patient population ages and becomes more complex, frequently necessitating a combination of both anticoagulation and antiplatelet agents, known as “triple therapy”. To reduce or treat thromboembolic disease states as well as reduce platelet aggregation for coronary stent protection, many patients are placed at an increased bleeding risk without compelling evidence of reduction in major adverse cardiac events. With this comprehensive review of the existing literature, we aim to analyse different strategies and durations of triple therapy medication regimens.

All over the world Class II malocclusions affects twenty percent of the population and Class II division 1 malocclusion is thought to be the most recognized problem practiced in orthodontics. A wide range of functional appliances including the removal and fixed are available for the correction of Class II skeletal pattern. The fixed functional appliances eliminate the need for patient compliance and place the treatment outcome under the control of the orthodontist. Patients with Class II mandibular retrusion and those whose growth is about to finish are typically treated with fixed functional appliances, which require little maintenance. William Vogt, was the first to introduce the Forsus appliance. Fixed functional appliances in general and the Forsus (FRD) in particular considerably speed up the correction of Class II Division 1 malocclusions and shorten treatment time as they are used in conjunction with a fully bonded fixed orthodontic appliance. Forsus primarily achieves Class II correction through dentoalveolar effects, but if utilized by patients who are at or near pubertal growth, it can result in skeletal changes as well.In this article, the management of two young adult patients with Class II Division 1 malocclusion and mandibular retrognathism is discussed. Both patients received a two-phase therapy in which first phase involved alignment of the arches with fixed orthodontic pre-adjusted appliance and second phase involved using the Forsus fixed functional appliance for at least six months.

Class II malocclusion cases are of interest to orthodontist since they constitute a significant percentage of cases they treat. However, they are one of the most challenging malocclusions to diagnose and treat.There lies a significant difference in prevalence of Class II malocclusion among various populations. Prevalence of Class II malocclusion in India varies from 1.9% in Rajasthan to 8.37% in South India.Class II malocclusions have dental or skeletal or combination entities. Success in the management of skeletal Class II cases especially in the adult cases relies on proper diagnosis and treatment planning. The treatment of severe dentofacial deformities in adult patients is a challenging task for both the orthodontist and the maxillofacial surgeon. In adults with severe discrepancy, combined orthosurgical approach is the ideal way to achieve acceptable results. This case report presents an adult male patient with severe Class II malocclusion in which mandibular advancement was carried out with BSSO. Post-treatment results showed improved facial esthetics and Class- I relationship of the skeletal jaw bases with optimal dental occlusion.

The effect of racial and ethnic variations of dental morphological traits on torque expression of preadjusted edgewise appliances has rarely been documented. This in vitro experiment was carried out with the aim to study the extent to which the anterior tooth morphology of a mixed Indian population affects torque expression of a preadjusted edgewise appliance. This study was conducted on extracted maxillary and mandibular anterior teeth of a mixed Indian population. These teeth were divided into two similar groups and were bonded with 0.018” Roth and MBT prescriptions. Full slot engagement was obtained using a 0.018” x 0.025” stainless steel wire to study how the variation in the tooth morphology affects the torque expression. Each tooth with the test wire engaged in the slot was radiographed using standardised procedures. The radiographs were photographed; images were transferred to a computer and enlarged 6 times. Printouts of the images were taken and the torque expression angle for each tooth of the two groups was measured. A wide range of torque expression was obtained reflecting the influence of tooth morphology on the expression of torque, suggestive of significant variations in the tooth morphology of the same tooth type. However, the mean torque expressions obtained in this study were comparable to the average values of torque prescribed for the two prescriptions.

Anatomic variations of mandibular molars are documented in literature. Variations in the anatomy are not appreciated by a great number of general dental practitioners. One such variation is occurrence of radix entomolaris, a supernumerary root occurring on the disto-lingual aspect of mandibular molars. This anomaly is rarely known to occur in the Indian population. Literature has also shown that the knowledge about the variations in the distal root anatomy in mandibular molars is not commonly known. This case reports the occurrence of radix entomolaris in mandibular first molar with three roots and four root canals. The case report discusses the frequency of occurrence, diagnostic means and endodontic management of radix entomolaris.

Introduction: Oral and dental health form an integral part of complete well being of an individual and society at large. Promoting oral health and societal progression go hand in hand. Aim: To investigate dentists' attitudes about pain and infection control while treating children and adolescents by assessing their recommendations of pre- and postoperative analgesics and antibiotics, and use of local anesthesia (LA) for definitive treatment in different clinical scenarios. Materials and Method: A total of 400 dentists, both general dental practitioners (GDPS) as well as specialist dentists, were surveyed over a period of 2 months by using a pre-tested close-ended questionnaire. The data was statistically analyzed using Pearson's Chi-square test and backward logistic regression analysis for analysis of categorical variables and independent variables, respectively. Level of significance was set at 5%. Results: It was found that there was a gross overuse of antibiotics and analgesics and under use of LA by GDPs compared to specialist dentists. Postoperative antibiotics and analgesics were used more commonly than preoperative antibiotics and analgesics. These strategies were used more often in permanent teeth than primary teeth except the use of LA, which was used with equal frequency in both primary as well as permanent dentition. Conclusion: Dependence on antibiotics and analgesics for achieving pain and infection control in children has to be minimized and focus has to be shifted on judicious definitive treatment involving use of LA, aseptic techniques, and behavior management techniques.

Mandibular retrusion is the most prevailing characteristic feature of Class II malocclusion. Removable Functional appliances and Fixed Functional Appliances (FFA) have been utilized for correction of Class II malocclusions in growing patients. This paper discusses the management of two young patients with Angles Class II Division 2 malocclusion with minimal growth remaining and with mandibular retrognathism who were treated with a two-phase therapy. The first phase involved alignment of arches with fixed Pre Adjusted Appliance (0.018”Roth). This was followed by a second phase involving application of Forsus fixed functional appliance for 6 months that resulted in unlocking of the mandible to Class I molar and canine relationship. Fixed Functional Appliances in general and the Forsus FRD in particular when used in conjunction with full bonded fixed appliance greatly facilitates the correction of Class II Division 2 malocclusions and the duration of the treatment is also reduced. Keywords: Retroclination, Forsus FRD.

Background International Medical Graduates (IMGs) contribute to about 23% of the physician workforce in the USA. Certain US-trained IMGs face long wait times for transitioning to a permanent resident status, which limits their ability to work to fullest capacity, especially during a public health emergency. Objectives To estimate the number of US-trained IMGs awaiting permanent residency. Study Design Data were obtained from National Residency Matching Program (NRMP) to quantify the number of IMGs who secured residency training in the US from 2004 to 2020. Estimates of physician demographics were based on NRMP/ECFMG 2014 match data and Federation of State Medical Boards (FSMB) physician census data. Results Between 2004 and 2020, a total of 57,160 non-US IMGs who were not US citizens successfully matched to residency training programs. Applicants from India and China were noted to be impacted by delays in adjustment to permanent resident status. Per our estimate, there are between 1,460 and 1,959 US-trained physicians from China currently awaiting permanent residency, with applicants waiting since October 2015, and between 13,250 and 14,230 US-trained physicians from India currently awaiting permanent residency, with applicants waiting since June 2009. Conclusions The total number of US-trained immigrant physicians in active practice awaiting permanent residency to the USA is estimated to be ranging between 14,710 and 16,189.

Purpose: Given that nearly a quarter of the US physician workforce are international medical graduates (IMGs), many of whom remain on temporary work visas for prolonged periods due to processing delays, the pandemic has posed unique challenges to these frontline workers and has arbitrarily limited our physician workforce. Objective: The objective of the study is to understand the role of IMG physicians practicing in the US, their limitations and challenges due to immigration related issues. Methods: Using a cross-sectional survey across social media platforms, we obtained data from IMGs regarding their role in healthcare, to the impact of visa-related restrictions on their personal and professional lives. Results: A total of 2630 IMGs responded to the survey, Hospital Medicine (1684, 65.7%) being the predominant specialty encountered. 64.1% were practicing in Medically Underserved Areas (MUA) or Health Professional Shortage Areas (HPSA), with 45.6% practicing in a rural area. Nearly 89% of respondents had been involved with direct care of COVID-19 patients, with 63.7% assuming administrative responsibilities for COVID-19 preparedness. 93% physicians expressed inability to serve in COVID-19 surge areas due to visa-related restrictions. 72% physicians reported that their families would be at risk for deportation in case of their disability or death. Most respondents (98.8%) felt that permanent resident status would help alleviate the above concerns. Conclusion: Easing immigration restrictions could prove significantly bolster the current physician workforce and prove beneficial in our response to the COVID-19 pandemic.

Plastic waste has gained global attention due to growing concerns about its impact on human and environmental health. More than 50% of manufactured plastics are disposed of after single-use, leading to 150 million tons of annual plastic waste worldwide. Although numerous efforts are underway to replace single-use plastic straws with alternative products to reduce environmental pollution, their potential impact on the environment, economy, and society is yet to be analyzed. This study considers plastic straws as an exemplar that captures the evolution of plastic use, its persisting problems, on-going efforts and advances in single-use plastic waste management, and the search for viable alternatives. We use the key principles of sustainability to explore the environmental, economic, and social impacts of different types of straw. In doing this, we contrast how producing drinking straws with (bio)materials could reduce their ecological impact, improve waste management. Additionally, we evaluate alternative approaches that have the potential to include straws within a broader “circular economy” strategy. However, alternative ways of producing straws only provide a partial solution. A broader beneficial effect on the environment will only be attained through consumer acceptance and behavioral changes. Any shift to resolve the persisting issues surrounding single-use plastics must be done from a systems approach to sustainability in order to mitigate environmental and economic risks and their rebound effects on the society.

Low serum bicarbonate, with or without an elevated anion gap, can indicate metabolic acidosis. High anion gap metabolic acidosis is due to the unmeasured anions. Hypertriglyceridemia can also be associated with spuriously low serum bicarbonate levels due to lab interference. We present a 44-year-old woman who presented with anion gap metabolic acidosis in the presence of severe hypertriglyceridemia

Syndrome of inappropriate antidiuretic hormone secretion may be a frequent accompaniment of aging without an obvious central nervous system or pulmonary disorder, tumor, or drugs as the confounding factor. Treatment is often warranted due to complex symptomatology that is often associated with unfavorable clinical outcomes. Although V2-receptor antagonists are effective in increasing serum sodium, their side-effect profile and cost may be a barrier to its use. We report a patient with symptomatic, severe, chronic hyponatremia requiring multiple hospitalizations, who was successfully maintained on long-term demeclocycline therapy.

Post-obstructive diuresis (POD) following decompression of urinary tract obstruction is usually a self-limiting phenomenon. However, prolonged bilateral ureteral obstruction (BUO) can cause severe structural and functional tubular damage. We present a case of POD resulting from partial nephrogenic diabetes insipidus and discuss the diagnosis, treatment, and prognosis.

Surgical-orthodontic management of hyper divergent skeletal Class III malocclusions is often confronted with clinical challenges. Overeruption of the maxillary second molars during longer presurgical orthodontic decompensation phase usually results in occlusal interferences which hinder the setting of desired postsurgical occlusion in preparation for model surgery. Here, a simple, yet effective interim modification of conventional Goshgarian-type transpalatal arch is proposed which can be effectively used to intrude over erupted molars during orthodontic treatment.

Uremic platelet dysfunction rarely causes significant bleeding in adequately dialyzed patients. When encountered, the management is complicated by a lack of well-supported treatment modalities. Estrogen use in uremic platelet dysfunction has been described, but enthusiasm for the treatment has been dampened by the risk of thrombotic events in vasculopathic dialysis patients. We present a patient on long-term peritoneal dialysis with coronary disease who developed recurrent life-threatening bleeding episodes secondary to uremia, where treatment with transdermal estrogen was used safely and effectively for a 24-month period.

Leadless pacemakers (PM) are developed to prevent pocket and lead-related complications. However, these new devices are not without adverse events. A 64-year-old man with end-stage renal disease, complete heart block, and leadless PM placed 3 months ago, presented with chest pain, shortness of

Background: Simultaneous intrusion and retraction of the anterior teeth is desirable to achieve optimum treatment results for orthodontic patients with deep overbite and flared incisors. The present study evaluates two different designs of arches for orthodontic intrusion and retraction of teeth. Methods: Thirty orthodontic patients, divided into two groups having an overbite more than 3 mm and requiring extraction of first premolars were included in the study. Model analysis and cephalometric analysis were carried out for each patient. 0.018" Roth prescription brackets were used. One group was treated using Three-piece intrusion arch. Kalra′s Simultaneous intrusion retraction arch was used for the other group. On obtaining desired verbite/overjet, the intrusion arches were removed. On accomplishment offinal finishing and detailing, the cases were placed on retention appliance. Result: Chair side time required for fabrication of both intrusion arches was almost similar. Both groups achieved more than 1.9 mm intrusion with minimal effects on the buccal segments. Conclusion: Both the designs of intrusion arch wires used in the present study allow the clinician to deliver a well-controlled force system with minimal chair side adjustments and with no additional deleterious effects on the buccal segments.