Background: Orthognathic surgery has become increasingly accurate with the integration of computerized technologies. This study aimed to evaluate the accuracy of custom-made plates in transferring the three-dimensional virtual plan to intraoperative maxillary repositioning. Methods: This study included 10 patients. A digital surgical simulation technique was used for preoperative planning. The surgical components— osteotomy/plates, locating guides, and customized titanium plates—were fabricated using computer-aided design and manufacturing techniques, replacing the need for a surgical splint. Postoperative outcomes were assessed using unaltered anatomical landmarks from the preoperative virtual plan. Absolute discrepancies in translational and rotational movements between the planned and actual postoperative positions were measured through superimposition analysis. This evaluation assessed the precision of custom-made plates in transferring the virtual surgical plan, identifying deviations in the cephalocaudal, mediolateral, and anteroposterior directions that could influence functional and esthetic outcomes. Results: No statistically significant differences were observed for any landmarks across the axial, coronal, and sagittal planes. The greatest variability was noted at the posterior nasal spine landmark in the axial plane (1.7 mm), compared with the coronal (0.9 mm) and sagittal (0.5 mm) planes. Conclusion Customized titanium plates effectively transferred the virtual surgical plan for maxillary repositioning without the need for an occlusal splint. However, potential posterior interference should be considered during surgical execution.

Dengue remains a public health threat that consumes a significant number of resources for its prevention and control. This systematic review aimed to solidify recent costing evidence in dengue management among South East Asian (SEA) countries. All studies conducted between 2010 and 2020 were retrieved using four international databases i.e. PubMed, Scopus, Web of Science, and Emerald Insight. The review was reported according to PRISMA guidelines. Quality assessments were done independently by two reviewers using a checklist adapted for the cost of illness studies. We identified 13 original articles representing several SEA countries. Among the common reported costing measure include total cost/ health expenditure; direct medical cost; direct non-medical cost; and indirect cost. The estimated total cost for dengue management varied between countries largely due to the difference in the total incidence of dengue cases. The estimated cost spent on dengue per capita GDP ranges from less than 0.001% to 0.1%, depending on the recorded number of dengue cases of the year. The majority of the articles focused on the economic burden from the perspective of treatment such as hospitalization and ambulatory care. In a nutshell, the economic burden of managing dengue infection is costly and the evidence suggests a steady increase in health expenditure with the growing number of dengue cases

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Purpose: This study evaluated the sensitivity, specificity, and accuracy of computed tomographic angiography (CTA) versus handheld Doppler (HHD) in detecting perforators for anterolateral thigh (ALT) flap surgery. Methods: This study was conducted on 20 patients randomly assigned to two groups from April 2023 to November 2024: One group received CTA and HHD, while the other group received only HHD. Perforators were evaluated for their number, location, and source and compared with intraoperative findings. Results: The sensitivity and specificity of CTA were 86.0% and 98.0%, respectively, while those of HHD were 81.0% and 86.5%. CTA exhibited an accuracy of 92.0% for perforator identification, whereas that of HHD was 83.5%. Conclusion CTA offers higher sensitivity, specificity, and accuracy in identifying ALT flap perforators than HHD. Its superior imaging capabilities can enable improved surgical planning, minimizing intraoperative challenges, reducing the risk of complications, and potentially increasing flap survival rates. As such, CTA could be considered a valuable standard tool in preoperative planning for ALT flap surgery, particularly in cases where anatomical variation poses a challenge.

Background: and Purpose Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. Methods: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). Results: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively).However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). Conclusions Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.