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Purpose: The aim of this study was to evaluate decision making with regard to detection and treatment of carious lesions on occlusal tooth surfaces and to evaluate the possible costs related to the different treatment plans of a group of clinicians in private practice.Materials and Methods: Forty extracted permanent teeth with no fillings or macroscopic carious cavitations were selected and radiographed, using a standard method similar to bitewing and then mounted in two models. A sample of 130 clinicians in private practice in Piracicaba, Brazil were asked to carry out combined visual-radiographic caries examination of the occlusal surfaces and to recommend possible treatment plans for each surface. Teeth were sectioned bucco-lingually and caries was assessed using a stereomicroscope and classified as either enamel or dentine lesions. The costs of treatments suggested by each examiner were calculated, using a fee scale reported by the Brazilian Federal Council of Dentistry.Results: Most teeth (53.7%) that were found to be sound on histological examination were considered to have enamel lesions. In 85.7% of these cases, the clinicians recommended restorative treatments. There was about 14-fold difference among clinicians concerning the costs related to decision making.Conclusion: Not only did the clinicians overestimate the presence and depth of carious lesions, but they also tended to treat enamel lesions using invasive therapeutic procedures. Great disparities were observed with regard to treatment costs related to decision making. Assuming an in vivo situation, the clinicians may be performing overtreatments and consequently interfering in the quality of patients' oral health. [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to determine if the well established neonatal illness severity scores CRIB(Clinical Risk Index for Babies) and SNAP(Score for Neonatal Acute Physiology) are also applicable to surgical neonates, and if these scores carry a meaningful predictive value. Methods: The records of all neonates with life threatening surgical anomalies (criteria according to Levi S. Ann N.Y. Ac. Sci.: 847:86-98,1997) admitted to our unit from January 1998 to January 1999, were reviewed. CRIB and SNAP scores were applied and the correlations with prolonged hospital stay ([is greater than] 1month) and mortality rate were sought. Statistical analysis was performed by Receiving Operating Characteristics(ROC) curves: predictive values were expressed as the areas under the curves. Area values [is less than] 0,5 were not predictive. Results: 96 neonates were evaluated: ROC curves were generated for each of the considered parameters. There was a statistically significant correlation for both scores regarding mortality (p [is less than] .00001; 95% CI:CRIB 0.63-0,90,SNAP 0.65-0.90), with an area under curve(Az) of 0.77 for CRIB and 0.78 for SNAP; however only SNAP was significant(p [is less than] .0001; 95% CI 0.88-0.96)regarding hospital stay, with an Az of 0,63 for CRIB and 0,93 for SNAP. Conclusions: SNAP was as significant for surgical newborns as it was for non-surgical intensive care neonates regarding mortality and hospital stay allowing appropriate resource allocation and cost containment. CRIB was not as useful in predicting prolonged hospital stay. New scores are needed to address outcome predictions of surgical neonates., C. Gatti, R. Pariante(*), V. Pardi, A. Trucchi, A. Nahom, A. Dotta(*), A. Zaccara, R. Laviani(*), P Bagolan, M. Orzalesi(*) and M.W.L. Gauderer , MD, FAAP; Neonatal Surgery and Intensive [...]

Background: The detection of carious lesions in the initial stages of development is very important in order to prevent the occurrence of cavitation. Aims and Objectives: The aim of the present study was to compare three methods-visual examination, FOTI, and bitewing radiographic examination-for the detection of noncavitated and cavitated approximal carious lesions. Materials and Methods: Seventy students (mean age 14 years) with low caries prevalence were examined by three examiners. The tooth surfaces judged as having caries by at least one examiner or one diagnostic method were scheduled for tooth separation. Results: The results showed that the incorporation of FOTI and radiographic examination represented an additional diagnostic yield of 50% and about 110%, respectively, compared to clinical examination alone. Conclusion: We conclude that FOTI or radiographic examination, or both, used as adjuncts to clinical examination, could improve the detection of noncavitated and cavitated approximal carious lesions. Although FOTI should not replace bitewing radiographic examination, it does seem to have additional value for the detection of carious lesions on approximal surfaces of the posterior teeth in school children with low caries prevalence.

This study investigated the correlation between sugar consumption and dental caries in a random sample of 184 schoolchildren (all 12 years of age) from public and private schools in Piracicaba, Brazil. A seven-day diet record was administered in a cross-sectional survey. Diet records were used to determine the frequency of sugar consumption both during and between meals. Socioeconomic and behavioral variables were collected in a semi-structured questionnaire. Using Community Periodontal Index (CPI) probes and mirrors and following WHO recommendations, a calibrated dentist assessed the number of decayed, missing, and filled surfaces (DMFS) on permanent teeth, the CPI, and the number of noncavitated (NC) carious lesions. Data analysis demonstrated significant correlations between NC carious lesions and sugar consumption during morning snack (p = 0.0282; r = 0.1618), NC carious lesions and sugar consumption during lunch (p = 0.0539; r = 0.1425), monthly family income and sugar consumption during dinner (p < 0.001; r = 0.2970), father's education and sugar consumption during dinner (p = 0.0027; r = 0.2430), and onset of toothbrushing and sugar consumption during dinner (p = 0.0159; r = 0.1786). A high consumption of sweet foods/beverages occurred between meals (mean = 17.48; standard deviation = 14.68). Although there was no correlation between DMFS and sugar consumption, there was a correlation between NC carious lesions and sugar consumption, indicating that the rational use of sugar is an important factor in caries prevention. [ABSTRACT FROM AUTHOR]

DESIGN: A randomised controlled trial (RCT) conducted over a period of 3 years. INTERVENTION: Either conventional glass-ionomer (Ketac-bond; 3M ESPE St. Paul, MN 55144-1000) or resin-modified glass-ionomer (Vitremer; 3M ESPE St. Paul, MN 55144-1000) sealants were applied to first permanent molars, and oral hygiene education was given. Clinical evaluations were carried out at 6, 12, 24, and 36 months after the application of the sealant. OUTCOME MEASURE: Retention rates and occlusal caries incidence were monitored. RESULTS: The difference in retention rates between the two materials was statistically significant. The experimental groups showed a caries incidence of 93, 78, 49, and 56% lower than the control group (P<0.01) for the four evaluation periods, respectively (see Table 1 Table 1Retention rates and occlusal caries incidence.Retention rates and occlusal caries incidence.Retention rates (n)Carious/filled occlusal surfaces (n)Ketac-bondVitremerKetac-bondVitremerControlPatients (n)50505050108Teeth at baseline (n)2002002002004321-year review123177642-year review3142417903-year review4132720110The number of occlusal surfaces that need to be treated with Ketac-bond to prevent one carious occlusal surface at 3 years is eight [95% confidence interval (CI), 5-18], and is six (95% CI, 5-10) for Vitremer.). CONCLUSIONS: The retention rates for glass-ionomer were low. Nevertheless, the statistically lower caries incidence in experimental groups compared with control group suggests a cariostatic effect.Evidence-Based Dentistry (2003) 4, 79. doi:10.1038/sj.ebd.6400225 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the ability of resveratrol to reduce dental caries in vitro and in vivo., Methods: In part 1, a microcosm biofilm protocol was employed. One hundred twenty-six bovine enamel specimens were treated with: Resveratrol (50, 100, 200, 400 µg/mL), Phosphate buffered saline (negative control), Dimethyl sulfoxide (negative control) and 0.12% Chlorhexidine (positive control). The biofilm was produced from the saliva of 10 volunteers, under 0.2% sucrose exposure for 5 days, and daily treated with the solutions (1 min). At the end of the experimental period, resazurin and viable plate count assays were performed. Enamel demineralization was evaluated by transverse microrradiography (TMR). In part 2, 12 volunteers participated in a triple-blind crossover protocol for 7 weeks, according to the following treatments: 1) 100 mg/L resveratrol; 2) 0.05% NaF (226 mg/L F); 3) 100 mg/L resveratrol + 0.05% NaF; 4) Deionized water (negative control). Biofilm samples were collected from both sides of the mouth 12 h after the use of the solutions., Results: Resveratrol at 50 and 200 µg/mL significantly reduced biofilm metabolic activity and mutans streptococci, respectively. Chlorhexidine was an effective treatment to significantly reduce all parameters, being an important antimicrobial and anticaries agent in vitro. Resveratrol alone or associated with NaF modulates several caries-associated bacteria in vivo., Conclusion: The present study represents the first step regarding the use of resveratrol within the concept of acquired enamel pellicle and biofilm engineering to prevent dental caries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background: In patients undergoing appendectomy, postoperative complications are more likely to occur with complicated appendicitis. Abdominal drainage may occasionally be used to prevent such scenarios. It is unclear, though, how abdominal drains help to reduce problems after surgery., Methods: Pediatric patients who underwent appendectomy for complicated appendicitis at a tertiary center between October 2021 and September 2022 were reviewed retrospectively. Following appendectomy, patients with and without peritoneal drains were contrasted in terms of preoperative characteristics and postoperative outcomes., Results: Thirty-seven of 83 patients (44.58%) undergoing emergency laparoscopic appendectomy for complicated appendicitis received abdominal drainage. The drain group had longer hospital stay (9 days [IQR 6-11] vs. 6 days [IQR 4-8], P=0.0002) and longer time to CRP normalization (6 days [IQR 4-9.5] vs. 8 days [7-12], P=0.0222) compared to the no-drain group. The drain group also had a higher complication rate (30.56% vs. 23.81%, P=0.6107), although such finding was not statistically significant., Conclusions: The use of abdominal drains after laparoscopic appendectomy did not significantly prevent postoperative complications in complicated appendicitis. Instead, it was associated with longer hospitalization, although patients in the drain group are likely to have experienced more severe conditions.

The measures implemented to contain the COVID-19 pandemic resulted in both behavioral and lifestyle changes. The "Changes in Lifestyle-Related Behavior" instrument was developed to assess lifestyle-related behaviors in the Indian population. However, considering current knowledge, this instrument was not adapted for the Brazilian population. In addition, the relationship between fear of COVID-19 and consumption of dietary supplements has not yet been evaluated. Thus, we aimed to investigate the relationship between the use of dietary supplements with lifestyle behavior and the fear of COVID-19, as well as assess the psychometric properties of the Brazilian version of the "Changes in Lifestyle-Related Behavior" instrument. An online questionnaire assessed sociodemographic, occupational, anthropometric, physical activity (International Physical Activity Questionnaire-short form), fear of COVID-19, and lifestyle behavior data from 416 Brazilian adults (237 females; 18-60y). Mann-Whitney, Chi-square test, exploratory, and confirmatory analyses were applied. Exploratory and confirmatory analyses showed a satisfactory adequacy level of the questionnaire (CMIN/DF = 2.689; Cronbach's α = 0.60) with 5 domains ('Bad eating behavior'; 'Healthy eating'; 'Sleep quality'; 'Interest in cooking'; 'Number of portions and meals'). Lower fear of COVID-19 scores and higher levels of physical activity were found in participants who reported previous dietary supplement intake during the pandemic; in addition, the group that did not ingest dietary supplements reported greater changes in stress and anxiety levels during the pandemic (p<0.05). The intake of dietary supplements before the pandemic was associated with greater energy expenditure and better coping with the fear of COVID-19 during the pandemic. Additionally, the Changes in Lifestyle-Related Behavior tool can be used to assess lifestyle-related variables during the pandemic., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tavares da Silva et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: Periodontitis (PD) has the potential to induce systemic changes that affect both physical and behavioral aspects. These alterations may be associated with changes in both the inflammatory profile and the oxidative stress status of individuals with PD. Therefore, we aimed to evaluate the effects of PD on oxidative stress, as well as on behavioral parameters and cognitive impairment, in a preclinical model., Material and Methods: Twenty-four male Wistar rats were randomly assigned to PD and sham groups. PD was induced by the ligature protocol for 14 days. Behavioral tests were initiated on the 9th day of the experiment to evaluate anxious behavior and cognition (learning and memory). After euthanasia, oxidative stress was evaluated in the gums, blood, hippocampus, and amygdala. Alveolar bone loss, bone microstructure, and elemental compositions of the mandibular bone were also assessed., Results: PD increased alveolar bone loss, reduced the calcium and phosphorus content in the mandibular bone, and increased anxiety-like behavior and cognitive decline (p < 0.05). Furthermore, PD significantly affected the redox balance, as evidenced by increased total antioxidant capacity (TAC) in the gingiva and hippocampus (p < 0.05). It also led to increased lipid peroxidation in the gingiva and erythrocytes (p < 0.05), decreased antioxidant defenses in erythrocytes (superoxide dismutase) and the hippocampus (catalase), and increased antioxidant activity (catalase) in the amygdala (p < 0.05)., Conclusion: PD resulted in cognitive alterations, including impairments in spatial learning and memory, as well as increased anxious behavior, likely due to redox imbalance in rats., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

School-based oral health programs are an effective approach to population-based care and a stalwart of public health, especially in rural and underserved communities. Lessons learned during the COVID-19 pandemic have informed contemporary strategies and policies to ensure integration into the delicate dental safety net in the Carolinas., Competing Interests: Acknowledgments: The team wishes to acknowledge one of the original thought leaders and influencers of our program design, Dr. Mark Doherty. We thank him posthumously for his visionary commitment to the design of the initiative. Funding: Funding for the SBOHP was made possible by The Duke Endowment (a major funder of the North Carolina Medical Journal) and the Blue Cross Blue Shield Foundations of both North and South Carolina., (Copyright ©2024 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Background: Current pectus excavatum management includes a computed tomography scan to evaluate the correction index, whose superiority to the Haller Index in terms of specificity and sensibility is still under debate. Furthermore, several studies report interchangeability between the Haller Index as measured by computed tomography and as measured by X-radiograph; however, it is not clear whether this correlation also exists for the correction index. The aim of our study was to evaluate the correlation between measurements of the Haller Index and the correction index obtained by Computed Tomography and by X-radiograph., Methods: This prospective study included 31 patients with pectus excavatum (who underwent preoperative chest computed tomography and X-radiograph) and a control group of 31 patients (who presented no chest deformity and underwent the same exams for other unrelated causes). We measured Haller Index and correction index on both exams for both groups. To demonstrate any correlation between computed tomography scans and X-radiographs for the two indexes, the Pearson R correlation test, Bland-Altman analysis, and ANOVA nested test were performed., Results: Pearson's coefficient (0.829 with P<0.0001) and ANOVA nested test showed a significant correlation and similar results between the Haller Index and the correction index on computed tomography and on X-radiograph., Conclusions: Significant correlation and similar results are shown in our study in the measurement of CI and HI on computed tomography and X-radiograph. Further studies including a larger number of patients may be warranted.

We aimed to determine the chemical profile and unveil Anadenanthera colubrina (Vell.) Brenan standardized extract effects on inflammatory cytokines expression and key proteins from immunoregulating signaling pathways on LPS-induced THP-1 monocyte. Using the RT-PCR and Luminex Assays, we planned to show the gene expression and the levels of IL-8, IL-1β, and IL-10 inflammatory cytokines. Key proteins of NF-κB and MAPK transduction signaling pathways (NF-κB, p-38, p-NF-κB, and p-p38) were detected by Simple Western. Using HPLC-ESI-MS n (High-Performance Liquid-Chromatography) and HPLC-HRESIMS, we showed the profile of the extract that includes an opus of flavonoids, including the catechins, quercetin, kaempferol, and the proanthocyanidins. Cell viability was unaffected up to 250 µg/mL of the extract (LD 50  = 978.7 µg/mL). Thereafter, the extract's impact on the cytokine became clear. Upon LPS stimuli, in the presence of the extract, gene expression of IL-1β and IL-10 were downregulated and the cytokines expression of IL-1β and IL-10 were down an upregulated respectively. The extract is involved in TLR-4-related NF-κB/MAPK pathways; it ignited phosphorylation of p38 and NF-κB, orchestrating a reduced signal intensity. Therefore, Anadenanthera colubrina's showed low cytotoxicity and profound influence as a protector against the inflammation, modulating IL-1β and IL-10 inflammatory cytokines gene expression and secretion by regulating intracellular NF-κB and p38-MAPK signaling pathways., (© 2024. The Author(s).)

Despite the known benefits, some individuals remain apprehensive about receiving the COVID-19 vaccine, which hampers vaccination efforts and the achievement of herd immunity. Therefore, this cross-sectional study aimed to assess vaccination rates and identify factors influencing fear of the COVID-19 vaccine among individuals served by the public healthcare system (Family Health Strategy - FHS) and in a university community in Minas Gerais, Brazil. Surveys were conducted face-to-face with FHS participants and online with university members, employing a free sharing approach on social media. A total of 1896 and 312 responses were collected, respectively. The survey covered sociodemographic information, COVID-19 fear levels, and vaccination status for both individuals and their children Vaccination coverage was 83% among FHS participants and 99.1% in the university setting. Female respondents in both groups exhibited higher levels of COVID-19 fear (p<0.05), with FHS-assisted women reporting greater apprehension towards vaccination (p<0.05). Educated parents demonstrated better understanding of the importance of child vaccination, while younger parents expressed heightened concerns about vaccine side effects. Among FHS participants, women exhibited a 1.6 times higher fear of vaccination compared to men. Additionally, fear of vaccination increased by 1.10 times for each additional point on the COVID-19 Fear Scale (physiological domain). Effective communication strategies and dispelling misconceptions surrounding immunization could alleviate fear and promote vaccination acceptance., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Botelho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: No biomarkers are currently available to predict therapeutic response to ustekinumab (UST) in Crohn's disease (CD). The aim of this prospective study was to identify 1 or more cytokines able to predict mucosal healing in patients with CD treated with UST., Methods: We prospectively enrolled consecutive CD patients treated with UST. At weeks 0 (baseline), 24, and 48, a panel of serum cytokines was measured by a fluorescence assay. At the same time points, fecal calprotectin (FC) was assessed. A colonoscopy was performed at baseline and at week 48, where therapeutic outcome was evaluated in terms of mucosal healing., Results: Out of 44 patients enrolled, 22 (50%) achieved mucosal healing at the end of follow-up. Response was associated with higher interleukin (IL)-23 levels (P < .01). Fecal calprotectin levels decreased over time in responders but did not change in nonresponders (test for the interaction between time and mucosal healing, P < .001)., Conclusions: This pilot study showed that IL-23 and FC could be reliable biomarkers in predicting therapeutic outcome to UST therapy in CD. In particular, the correlation between baseline serum levels of IL-23 and mucosal healing at 48 weeks is particularly strong, paving the way for its use to drive therapeutic decisions., (© The Author(s) 2024. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Introduction: International research suggests that poor patient compliance is the main cause of tutor failures in the context of potential novel orthopedic bivalve braces for conservative treatment of pectus carinatum. Our entire experimental study is based on the hypothesis that a rigid bivalve brace that patients can accept could solve the main problem associated with the conservative approach-poor compliance. The hypothesis was to reduce the thickness and weight of the classic bivalve brace to ensure concealment and make it sustainable enough to be worn several hours a day without compromising its therapeutic efficacy., Materials and Method: The research was conducted from January 2020 to December 2022 to ensure follow-up of all participants for at least 6 months. In 36 months, 140 patients with pectus carinatum were assessed and conservatively treated with the studied guardian to analyze the therapeutic efficacy of the bivalve brace and patient compliance. From the initial visit, the parents and patient were informed that this is a 2-year therapeutic course during which the bivalve brace should be worn at least 23 h a day (with 1 h of abstinence per day for routine personal hygiene practices). Compliance is the key to therapy success, and the duration of treatment depends on patient adherence., Results: The exceptional effectiveness of the experimental brace was confirmed by both the questionnaire from the patients (with an average satisfaction rate of 8.9/10) and an assessment of the therapy's results by a properly selected medical committee (with a VAS scale satisfaction of 7.2/10 for symmetric forms and 7.1/10 for asymmetric ones)., Conclusion: In conclusion, the analyzed data confirmed the research hypotheses. First, none of the 140 patients had cardiovascular diseases directly related to their condition, confirming that pectus carinatum is a pathology of a purely aesthetic nature. Second, a cheap, lightweight, and easily obscured brace significantly improved patient compliance. Along with this, the social relevance of the aesthetic aspect today may be an important factor in motivating the study cohort to adhere to therapy. In the past, esthetics and appearance were less relevant at the social level, which may have contributed to the high abandonment and reduced compliance rates of the many studies in the literature., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. The handling editor FM declared a past co-authorship with the authors AB and AI., (© 2024 Frediani, Zarfati, Pardi, Aloi, Bertocchini, Accinni, Beati, Pasanisi and Inserra.)

Purpose: Femoral hernia (FH) is a rare and often misdiagnosed pathology in pediatric population. The aim of our study was to describe the experience of a Tertiary Center in children with FH, underlying diagnostic and surgical details that could improve its management., Methods: A retrospective study of pediatric patients who underwent FH repair from January 2010 to June 2023 at our Institution was performed., Results: In the analyzed period, 31 patients underwent surgical procedure for FH at our institution, of whom 16 (51.6%) were female. The mean age at time of surgery was 5.8 years (range 0.5-17.1 years). The rate of pre-operative misdiagnosis was 35.5% and open approach was adopted in all cases (16.1% with mesh application). Only two patients (6.4%) experienced surgical complications: one recurrence (repaired six months later) and one post-operative hematoma (treated successfully with conservative method)., Conclusion: Due to the high rate of misdiagnosis, the variety of surgical approaches proposed, and the potential for intraoperative complications, FH poses a challenge for pediatric surgeons and urologists, as confirmed by the literature. It is essential to underline the importance of a proper clinical examination in order to correctly diagnose FH, make the best surgical plan for the patient and prevent post-operative complications., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: No age-specific pediatric guidelines exist for the management of spontaneous pneumothorax (SP) in children and adolescents. Treatment remains heterogeneous and center dependent. The role of computed tomography (CT) has yet to be defined., Aims: Review the management of SP in children and adolescents, with emphasis on conservative management and role of CT., Methods: Retrospective analysis of 61 consecutive patients with SP at single tertiary center. Clinical, radiological, surgical data, follow-up, and outcomes were revised., Results: First-line management was conservative for 32 (53%) patients and operative for 29 (47%). Asymptomatic/paucisymptomatic patients managed conservatively experienced less first-line treatment failure. Furthermore, the patients needing at least a chest drain or surgery during the follow-up were significantly lower in the conservative group. Conservative and operative patients showed no significant differences regarding ipsilateral recurrences or contralateral occurrences. Of the 61 overall CTs performed, 14 (23%) had an impact on management. Forty-three (70%) patients had at least a CT, in 22 (51%) the CT was positive for blebs. For 10 of these patients (45%) the presence of blebs had an impact on management. Patients with and without blebs showed no differences regarding ipsilateral recurrence, contralateral occurrences, or the need for at least a chest drain or surgery during the follow-up., Conclusions: First-line conservative management had a significantly shorter hospitalization and better outcome, with a similar incidence of recurrences. The presence of blebs at CT does not predict the risk of recurrence. The CT scan should be reserved for a small number of selected patients who have post-VATS refractory or recurrent pneumothorax., (© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

Background: Laparoscopic appendectomy followed by postoperative intravenous (IV) antibiotics is the standard of care for acute appendicitis and postoperative prevention of intra-abdominal abscesses. The aim of or study was to determine if intraperitoneal irrigation with antibiotics could help prevent intra-abdominal abscess formation after laparoscopic appendectomy for complicated appendicitis in pediatric patients., Methods: A retrospective study was conducted on consecutive pediatric patients with acute appendicitis who had appendectomy in our Pediatric Surgery Department between August 2020 and February 2022. We compared two groups with similar age and symptoms. The first group (A) was treated with the normal standard of care, i.e., laparoscopic appendectomy and postoperative IV antibiotic therapy. For the second group (B) intraperitoneal cefazoline irrigation was added at the end of the laparoscopic procedure. Postoperative intra-abdominal abscess was diagnosed with ultrasound examination, performed after clinical suspicion/abnormal blood test results., Results: One hundred sixty patients (males:females 109:51; median age 10.5 years [range 3-17 years]) who had laparosopic appendectomy for complicated appendicitis were included, 82 in group A and 78 in group B. In the first 7 days after surgery, 18 patients in group and 5 in group B developed an intra-abdominal abscess (p < 0.005). Drains were positioned in 38 patients in group A vs. 9 in group B. One patient in group A had a different complication which was infection of the surgical incision., Conclusions: Intraperitoneal cefazoline irrigation at the end of the laparoscopic appendectomy in pediatric patients significantly reduces the formation of intra-abdominal abscesses.

Background and Objectives: Marfan syndrome (MS) is a systemic disease of connective tissues consisting of a variable combination of anomalies. These patients have an increased risk of spontaneous pneumothorax (SP). However, there is a scarcity of pediatric literature on management, and no specific guidelines exist. Our aim was to analyze the management of spontaneous pneumothorax in children and adolescents with Marfan syndrome, comparing syndromic and non-syndromic patients., Methods: Retrospective analysis of pediatric patients (18 years) with SP diagnosed at our tertiary pediatric hospital (January 10-June 22), with special emphasis on diagnosis, treatment, and follow-up (FU)., Results: Sixty-six patients with SP were identified, with nine (13%) having MS. In terms of baseline, there were no significant differences between the groups (age, sex, asthma, symptoms, and side, first-line treatment and hospitalization length). Overall, Marfan patients had significantly more first-line treatment failures requiring additional surgery, as well as more contralateral occurrences and the need for surgery/chest drain during the follow-up. Instead, conservative management resulted in significantly more ipsilateral recurrences and the need for surgery/chest drain in Marfan patients than controls during the follow-up., Conclusions: Treatment failure, contralateral occurrence, ipsilateral recurrence, and the need for surgery/chest drain during follow-up make management of patients with Marfan syndrome and spontaneous pneumothorax more difficult. In patients with a diagnosed MS a more aggressive first-line management should be considered, bearing in mind the higher risks of this population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. The reviewer GC declared a past co-authorship with the author AI to the handling editor., (© 2023 Zarfati, Frediani, Pardi, Aloi, Madafferi, Accinni, Bertocchini and Inserra.)

Background and Aims: Thoracic air leak syndrome (TALS) is a complication related to chronic pulmonary graft-versus-host disease (pGvHD) that affects approximately 0.83%-3.08% patients after allogenic hematopoietic stem cell transplant. Such complication is defined as the occurrence of any form of air leak in the thorax, including spontaneous pneumomediastinum or pneumopericardium, subcutaneous emphysema, interstitial emphysema and pneumothorax and has a negative impact on post-transplant survival. The aim of the present study is to describe a single-center experience in the surgical management of recurrent TALS in adolescents and young adults and its outcome., Methods: We retrospectively reviewed the clinical notes of patients with previous allogenic hematopoietic stem cell transplant who underwent surgical procedures for recurrent TALS from January 2016 until March 2021. We analyzed clinical data, number of episodes of thoracic air leak, surgical procedures and relative outcome., Results: In the examined period, four patients, aged 16-25 years, underwent surgical procedures for TALS, including thoracostomy tube placement, thoracoscopic pleurodesis and thoracotomy. All the patients had been diagnosed with pGvHD before the onset of TALS, with a mean time lapse of 276 days (range 42-513). These patients experienced on average 4.5 air leak episodes (range 3-6). All the patients experienced at least two episodes before surgery. One patient underwent emergency tube thoracostomy only, three patients underwent thoracoscopic pleurodesis and two patients underwent thoracotomy. After surgery, patients were free from air leak symptoms for a mean time of 176 days (range 25-477). Pulmonary function progressively deteriorated, and all the patients eventually died because of respiratory failure after a mean time of 483 days (range 127-1045) after the first episode of air leak., Conclusions: Surgery provides temporary relief to symptoms related to TALS but has limited effects on the underlying pathophysiologic process. The development of TALS in a sign of progressive pulmonary function worsening and is associated with high risk of respiratory failure and mortality., (© 2023 The Authors. Pediatric Pulmonology published by Wiley Periodicals LLC.)

This study aimed to investigate the relationship between food choices and periodontal health status (PHS) in adults who receive care through a public health system. We evaluated food preferences and periodontal status in a sample of 442 individuals with at least eight natural teeth. We employed the Food Frequency Questionnaire (FFQ) to assess food choices and the Periodontal Screening and Recording (PSR) instrument to evaluate periodontal health status during clinical appointments. Fisher's discriminant analysis was used to differentiate the participants according to PHS severity within three age-ranges (18-39; 40-59 and > 60 years-old). The results showed that the prevalence of overweight/obesity was high in all age groups (above 65%), and BMI increased with age, accompanied by an increase in the prevalence of chronic diseases. A lower preference for natural foods and a higher intake of processed and ultra-processed foods, along with a high waist circumference and diabetes, were associated with a poorer periodontal health status. In the 18-39 age group, a lower waist circumference was associated with healthier periodontal status. In the 40-59 age group, a worse periodontal status resulted from a higher frequency of diabetes, lower intake of green leafy vegetables, olive oil, and fruit, and higher intake of industrialized juice. Conversely, a healthier periodontal status was associated with a lower frequency of diabetes and higher intake of fruit and vegetables. In the > 60age group, the worst periodontal status was associated with male sex. Overall, the study highlights the possible beneficial role of a healthy diet in maintaining periodontal health, particularly for those who receive care through a public health system., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Canaan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The digital chest drainage monitoring system (Medela Thopaz+), unlike analogical systems, reliably regulates the pressure applied to the patient's chest and digitally and silently monitors critical therapeutic indicators (volume of fluid and/or drained air). Its use in adulthood has been widely described, but there is still little experience in the pediatric field. The aim of this study is to test this new device in the pediatric population., Materials and Methods: We conducted a retrospective study of 160 patients undergoing chest surgery at our Hospital. These patients were divided into 82 treated with the Thopaz system in the period from January 2021 to April 2023 and 78 in whom Pleurevac, had been used in the time period from January 2020 to April 2023., Results: The average age of patients was 10.45 years (range: 3.1-17.2) for the Thopaz Group and 10.71 years for Pleurevac Group. The groups were homogeneus also by weight and type of intervention. The device was held in place for 10.64 days (mean) for Thopaz Group, compared to 16.87 days (mean) for Pleurevac Group ( p  < 0.05). The median number of postoperative x-rays before the closure of the chest tube was 4.29 in the digital drainage group compared to 8.41 in the traditional draining group ( p  < 0.05)., Conclusions: The digital chest monitoring device provides objective measurement, allows for rapid patient mobilization (with good pain control and increased compliance). In addition, the use of Thopaz in the paediatric population seems to be safe (there is no statistically significant difference in terms of complications such as prolonged air leaks and pneumothorax after the chest tube closure) and potentially beneficial., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2023 Frediani, Romano, Pardi, Aloi, Bertocchini, Accinni, Zarfati and Inserra.)

Objective: To assess disparities in preventive dental service use in four major racial/ethnic groups and assess whether racial/ethnic and income-related disparities among children were reduced from 2016 to 2020., Methods: Data were from the 2016 and 2020 National Survey of Children's Health (NSCH). The outcomes of interest were having dental sealants, fluoride treatment, and dental caries in the past 12 months. Racial/ethnic groups included non-Hispanic (NH) whites, blacks, Hispanics, Asians, and others. Family income level was categorized as below or above the 200% federal poverty level (low-income vs. high-income). Children ages 2-17 were included (N = 161,539). All data were self-reported by parents/guardians. We estimated the trends of racial/ethnic disparities in having fluoride treatment, dental sealants, and dental caries from 2016 to 2020 and tested two 2-way interactions (i.e., year by race/ethnicity, year by income) and one 3-way interaction (year by income by race/ethnicity) to assess the change in disparities from 2016 to 2020., Results: Overall, no significant trends in receipt of fluoride treatment, dental sealants, or having dental caries were found from 2016 to 2020 among the racial/ethnic groups, except for a decreasing trend in dental sealants for Asian American children (p = 0.03). Overall, NH white children were more likely to have received preventive dental services than children from minority groups (all p < 0.05); Asian American children (AOR = 1.31) were more likely to have dental caries than NH white children., Conclusion: Disparities in receipt of evidence-based preventive services by children persisted. Continuous efforts are needed to promote the use of preventive dental services among children of minority populations., (© 2023 American Association of Public Health Dentistry.)

Objective:  This study assessed maternal mortality (MM) and related factors in a large-sized municipality in the Southeastern region of Brazil (Campinas, São Paulo) during the period 2000-2015., Methods:  This study consisted of two phases: 1. An analytical nested case-control phase that assessed the impact of individual and contextual variables on MM; and 2. an ecological phase designed to contextualize maternal deaths by means of spatial analysis. The case group consisted of all maternal deaths (n = 87) and the control group consisted of 348 women who gave birth during the same period. Data analysis included descriptive statistics, association, and multiple logistic regression (MLR) tests at p < 0.05 as well as spatial analysis., Results:  Maternal Mortality Ratio was 37 deaths per 100.000 live births. Deaths were dispersed throughout the urban territory and no formation of cluster was observed. MLR showed that pregnant women aged ≥ 35 years old (OR = 2.63) or those with cesarean delivery (OR = 2.51) were more prone to maternal death., Conclusion:  Maternal deaths were distributed dispersedly among the different socioeconomic levels and more prone to occur among older women or those undergoing cesarean deliveries., Competing Interests: None to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Background: Population studies consistently demonstrate a greater prevalence of chronic diseases, including oral diseases, among underrepresented minorities. This retrospective study aimed to measure and describe the prevalence and extent of periodontitis among adults seeking dental care within an academic practice-based network in rural North Carolina., Methods: This study used de-identified electronic health record (EHR) data from 2011 to 2017 of adult dentate patients (aged ≥30 years) seeking dental care who received a comprehensive periodontal examination at one of nine networked clinical centers. Periodontitis prevalence was calculated using CDC/AAP case definitions, along with extent (%) scores for periodontal parameters. Comparisons focused on age, sex, race, ethnicity, tobacco use, diabetes status, payer or insurance status, plaque scores, and the number of teeth., Results: EHR data for 10,544 adult patients (60.5% female) indicated 79.8% had some form of periodontitis. This patient population was diverse: 22.6% Black, 4.4% American Indian, and 53.8% White, with 4.8% self-identified as Hispanic. Patients 50 years and older showed greater mean extent scores for clinical attachment levels relative to patients 30 to 49 years. Males exhibited greater periodontitis than females (p = 0.001). Blacks showed significantly (p < 0.001) greater periodontitis prevalence relative to Whites. Hispanics also showed a greater prevalence of periodontitis (p < 0.001) relative to non-Hispanics. Significantly greater periodontitis was also noted for tobacco users (p < 0.001) but not for diabetes or payer status. A multiple logistic regression analysis of periodontitis prevalence confirmed significant associations for periodontitis for age, sex, race, ethnicity, tobacco use, high plaque scores, and the number of teeth (p < 0.001), but not diabetes or payer status., Conclusions: The data document that racial and ethnic inequalities in periodontal health occur within the population of adults residing in rural communities in North Carolina and seeking dental care., (© 2022 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology.)

Background: The importance of crestal soft tissue thickness and its influence in peri-implant tissue health has been evaluated in few clinical studies. Cone beam computed tomography imaging offers a unique opportunity to investigate variations in crestal soft tissue thickness. The aim of this retrospective study was to evaluate the possible correlation between crestal soft tissue thickness and hard tissue measurements on CBCT images, and to compare crestal soft tissue thickness among different patients and edentulous site groups., Methods: CBCT images of partially edentulous adult patients treated at ECU School of Dental Medicine were evaluated. 267 patients with 321 edentulous sites were included. Demographic data were collected from electronic health records. Cross-sectional CBCT images at the center of each edentulous site were used to measure soft tissue and hard tissue parameters. Linear mixed models were used to compare crestal soft tissue thickness and hard tissue measurements by gender, age groups, and edentulous sites. Pearson correlation was applied to evaluate the correlation between crestal soft tissue thickness and different hard tissue measurements. Association between crestal soft tissue thickness and independent variables (gender, age groups, edentulous sites) was evaluated using repeated measure logistic regression, while the crestal soft tissue thickness was dichotomized by a threshold of 2 mm., Results: Mean age of patients included was 60 (range 21-85 years). Female to male ratio was 1.07. Mean crestal soft tissue thickness of all non-grafted native bone sites was 2.17 mm. Mean thickness of cortical bone at alveolar crest was 0.94 mm. Thickness of buccal and lingual cortical plates 5 mm apical to alveolar crest were 1.17 mm and 1.58 mm, respectively. Pearson's correlation showed moderate positive correlation among hard tissue measurements, but weak correlation between soft tissue thickness and hard tissue measurements. Anterior sites [OR = 3.429 (1.100-10.69)] and maxillary posterior sites [OR = 1.937 (1.077-3.482)] had higher odds of presenting with more than 2 mm of soft tissue at the alveolar crest., Conclusion: More than half of the patients had crestal soft tissues at edentulous sites thicker than 2 mm. Thickness of crestal soft tissue was not significantly associated with hard tissue measurements. Edentulous anterior sites and maxillary posterior sites presented with thicker crestal soft tissue at alveolar crest as compared to mandibular posterior sites., (© 2022. The Author(s).)

Background: Candlenut (CN) has been used indiscriminately for weight loss. In vivo effects of CN in different doses are scarce., Objective: To evaluate the effects of CN ingestion in obese rats., Design: Thirty animals (obese and non-obese) received one of three different types of treatments: placebo, CN ingestion in a popular therapeutic regimen (8 days with oral administration of 0.2 mg/kg followed by 20 days with doses of 0.4 mg/kg), and ingestion of a doubled popular dose-called 2CN. Treatment was maintained for 28 days., Results: The fatty acid profile of CN indicated mainly linolelaidic and palmitoleic acids. Rats receiving CN and 2CN showed reduced plasmatic levels of glucose and lipoproteins (p < 0.05). A dose-dependent carcass fat reduction was observed (p < 0.05). Blood levels of aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) reduced with CN and increased with 2CN doses (p < 0.05). Alanine aminotransferase (ALT) and the atherogenic index remained similar among all treatments (p > 0.05). Hepatic vacuolation decreased with CN, but the 2CN dose produced mononuclear leucocyte infiltrate., Conclusions: Although CN presented beneficial effects on the metabolism of rats, it also caused increased risk of liver damage., (© 2022. The Author(s).)